studies in education journal

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Harvard educational review.

Edited by Maya Alkateb-Chami, Jane Choi, Jeannette Garcia Coppersmith, Ron Grady, Phoebe A. Grant-Robinson, Pennie M. Gregory, Jennifer Ha, Woohee Kim, Catherine E. Pitcher, Elizabeth Salinas, Caroline Tucker, Kemeyawi Q. Wahpepah

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Journal Information

• ISSN: 0017-8055
• eISSN: 1943-5045
• Keywords: scholarly journal, education research
• First Issue: 1930
• Frequency: Quarterly

Description

The Harvard Educational Review (HER) is a scholarly journal of opinion and research in education. The Editorial Board aims to publish pieces from interdisciplinary and wide-ranging fields that advance our understanding of educational theory, equity, and practice. HER encourages submissions from established and emerging scholars, as well as from practitioners working in the field of education. Since its founding in 1930, HER has been central to elevating pieces and debates that tackle various dimensions of educational justice, with circulation to researchers, policymakers, teachers, and administrators.

Our Editorial Board is composed entirely of doctoral students from the Harvard Graduate School of Education who review all manuscripts considered for publication. For more information on the current Editorial Board, please see here.

A subscription to the Review includes access to the full-text electronic archives at our Subscribers-Only-Website .

Editorial Board

2023-2024 Harvard Educational Review Editorial Board Members

Maya Alkateb-Chami Development and Partnerships Editor, 2023-2024 Editor, 2022-2024 [email protected]

Maya Alkateb-Chami is a PhD student at the Harvard Graduate School of Education. Her research focuses on the role of schooling in fostering just futures—specifically in relation to language of instruction policies in multilingual contexts and with a focus on epistemic injustice. Prior to starting doctoral studies, she was the Managing Director of Columbia University’s Human Rights Institute, where she supported and co-led a team of lawyers working to advance human rights through research, education, and advocacy. Prior to that, she was the Executive Director of Jusoor, a nonprofit organization that helps conflict-affected Syrian youth and children pursue their education in four countries. Alkateb-Chami is a Fulbright Scholar and UNESCO cultural heritage expert. She holds an MEd in Language and Literacy from Harvard University; an MSc in Education from Indiana University, Bloomington; and a BA in Political Science from Damascus University, and her research on arts-based youth empowerment won the annual Master’s Thesis Award of the U.S. Society for Education Through Art.

Jane Choi Editor, 2023-2025

Jane Choi is a second-year PhD student in Sociology with broad interests in culture, education, and inequality. Her research examines intra-racial and interracial boundaries in US educational contexts. She has researched legacy and first-generation students at Ivy League colleges, families served by Head Start and Early Head Start programs, and parents of pre-K and kindergarten-age children in the New York City School District. Previously, Jane worked as a Research Assistant in the Family Well-Being and Children’s Development policy area at MDRC and received a BA in Sociology from Columbia University.

Jeannette Garcia Coppersmith Content Editor, 2023-2024 Editor, 2022-2024 [email protected]

Jeannette Garcia Coppersmith is a fourth-year Education PhD student in the Human Development, Learning and Teaching concentration at the Harvard Graduate School of Education. A former public middle and high school mathematics teacher and department chair, she is interested in understanding the mechanisms that contribute to disparities in secondary mathematics education, particularly how teacher beliefs and biases intersect with the social-psychological processes and pedagogical choices involved in math teaching. Jeannette holds an EdM in Learning and Teaching from the Harvard Graduate School of Education where she studied as an Urban Scholar and a BA in Environmental Sciences from the University of California, Berkeley.

Ron Grady Editor, 2023-2025

Ron Grady is a second-year doctoral student in the Human Development, Learning, and Teaching concentration at the Harvard Graduate School of Education. His central curiosities involve the social worlds and peer cultures of young children, wondering how lived experience is both constructed within and revealed throughout play, the creation of art and narrative, and through interaction with/production of visual artifacts such as photography and film. Ron also works extensively with educators interested in developing and deepening practices rooted in reflection on, inquiry into, and translation of the social, emotional, and aesthetic aspects of their classroom ecosystems. Prior to his doctoral studies, Ron worked as a preschool teacher in New Orleans. He holds a MS in Early Childhood Education from the Erikson Institute and a BA in Psychology with Honors in Education from Stanford University.

Phoebe A. Grant-Robinson Editor, 2023-2024

Phoebe A. Grant-Robinson is a first year student in the Doctor of Education Leadership(EdLD) program at the Harvard Graduate School of Education. Her ultimate quest is to position all students as drivers of their destiny. Phoebe is passionate about early learning and literacy. She is committed to ensuring that districts and school leaders, have the necessary tools to create equitable learning organizations that facilitate the academic and social well-being of all students. Phoebe is particularly interested in the intersection of homeless students and literacy. Prior to her doctoral studies, Phoebe was a Special Education Instructional Specialist. Supporting a portfolio of more than thirty schools, she facilitated the rollout of New York City’s Special Education Reform. Phoebe also served as an elementary school principal. She holds a BS in Inclusive Education from Syracuse University, and an MS in Curriculum and Instruction from Pace University.

Pennie M. Gregory Editor, 2023-2024

Pennie M. Gregory is a second-year student in the Doctor of Education Leadership (EdLD) program at the Harvard Graduate School of Education. Pennie was born in Incheon, South Korea and raised in Gary, Indiana. She has decades of experience leading efforts to improve outcomes for students with disabilities first as a special education teacher and then as a school district special education administrator. Prior to her doctoral studies, Pennie helped to create Indiana’s first Aspiring Special Education Leadership Institute (ASELI) and served as its Director. She was also the Capacity Events Director for MelanatED Leaders, an organization created to support educational leaders of color in Indianapolis. Pennie has a unique perspective, having worked with members of the school community, with advocacy organizations, and supporting state special education leaders. Pennie holds an EdM in Education Leadership from Marian University.

Jennifer Ha Editor, 2023-2025

Jen Ha is a second-year PhD student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Her research explores how high school students learn to write personal narratives for school applications, scholarships, and professional opportunities amidst changing landscapes in college access and admissions. Prior to doctoral studies, Jen served as the Coordinator of Public Humanities at Bard Graduate Center and worked in several roles organizing academic enrichment opportunities and supporting postsecondary planning for students in New Haven and New York City. Jen holds a BA in Humanities from Yale University, where she was an Education Studies Scholar.

Woohee Kim Editor, 2023-2025

Woohee Kim is a PhD student studying youth activists’ civic and pedagogical practices. She is a scholar-activist dedicated to creating spaces for pedagogies of resistance and transformative possibilities. Shaped by her activism and research across South Korea, the US, and the UK, Woohee seeks to interrogate how educational spaces are shaped as cultural and political sites and reshaped by activists as sites of struggle. She hopes to continue exploring the intersections of education, knowledge, power, and resistance.

Catherine E. Pitcher Editor, 2023-2025

Catherine is a second-year doctoral student at Harvard Graduate School of Education in the Culture, Institutions, and Society program. She has over 10 years of experience in education in the US in roles that range from special education teacher to instructional coach to department head to educational game designer. She started working in Palestine in 2017, first teaching, and then designing and implementing educational programming. Currently, she is working on research to understand how Palestinian youth think about and build their futures and continues to lead programming in the West Bank, Gaza, and East Jerusalem. She holds an EdM from Harvard in International Education Policy.

Elizabeth Salinas Editor, 2023-2025

Elizabeth Salinas is a doctoral student in the Education Policy and Program Evaluation concentration at HGSE. She is interested in the intersection of higher education and the social safety net and hopes to examine policies that address basic needs insecurity among college students. Before her doctoral studies, Liz was a research director at a public policy consulting firm. There, she supported government, education, and philanthropy leaders by conducting and translating research into clear and actionable information. Previously, Liz served as a high school physics teacher in her hometown in Texas and as a STEM outreach program director at her alma mater. She currently sits on the Board of Directors at Leadership Enterprise for a Diverse America, a nonprofit organization working to diversify the leadership pipeline in the United States. Liz holds a bachelor’s degree in civil engineering from the Massachusetts Institute of Technology and a master’s degree in higher education from the Harvard Graduate School of Education.

Caroline Tucker Co-Chair, 2023-2024 Editor, 2022-2024 [email protected]

Caroline Tucker is a fourth-year doctoral student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Her research focuses on the history and organizational dynamics of women’s colleges as women gained entry into the professions and coeducation took root in the United States. She is also a research assistant for the Harvard and the Legacy of Slavery Initiative’s Subcommittee on Curriculum and the editorial assistant for Into Practice, the pedagogy newsletter distributed by Harvard University’s Office of the Vice Provost for Advances in Learning. Prior to her doctoral studies, Caroline served as an American politics and English teaching fellow in London and worked in college advising. Caroline holds a BA in History from Princeton University, an MA in the Social Sciences from the University of Chicago, and an EdM in Higher Education from the Harvard Graduate School of Education.

Kemeyawi Q. Wahpepah Co-Chair, 2023-2024 Editor, 2022-2024 [email protected]

Kemeyawi Q. Wahpepah (Kickapoo, Sac & Fox) is a fourth-year doctoral student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Their research explores how settler colonialism is addressed in K-12 history and social studies classrooms in the United States. Prior to their doctoral studies, Kemeyawi taught middle and high school English and history for eleven years in Boston and New York City. They hold an MS in Middle Childhood Education from Hunter College and an AB in Social Studies from Harvard University.

Submission Information

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Contact Information

Click here to view contact information for the editorial board and customer service .

Subscriber Support

Individual subscriptions must have an individual name in the given address for shipment. Individual copies are not for multiple readers or libraries. Individual accounts come with a personal username and password for access to online archives. Online access instructions will be attached to your order confirmation e-mail.

Institutional rates apply to libraries and organizations with multiple readers. Institutions receive digital access to content on Meridian from IP addresses via theIPregistry.org (by sending HER your PSI Org ID).

Online access instructions will be attached to your order confirmation e-mail. If you have questions about using theIPregistry.org you may find the answers in their FAQs. Otherwise please let us know at [email protected] .

How to Subscribe

To order online via credit card, please use the subscribe button at the top of this page.

To order by phone, please call 888-437-1437.

Checks can be mailed to Harvard Educational Review C/O Fulco, 30 Broad Street, Suite 6, Denville, NJ 07834. (Please include reference to your subscriber number if you are renewing. Institutions must include their PSI Org ID or follow up with this information via email to [email protected] .)

Permissions

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Article Submission FAQ

Submissions, question: “what manuscripts are a good fit for her ”.

Answer: As a generalist scholarly journal, HER publishes on a wide range of topics within the field of education and related disciplines. We receive many articles that deserve publication, but due to the restrictions of print publication, we are only able to publish very few in the journal. The originality and import of the findings, as well as the accessibility of a piece to HER’s interdisciplinary, international audience which includes education practitioners, are key criteria in determining if an article will be selected for publication.

We strongly recommend that prospective authors review the current and past issues of HER to see the types of articles we have published recently. If you are unsure whether your manuscript is a good fit, please reach out to the Content Editor at [email protected] .

Question: “What makes HER a developmental journal?”

Answer: Supporting the development of high-quality education research is a key tenet of HER’s mission. HER promotes this development through offering comprehensive feedback to authors. All manuscripts that pass the first stage of our review process (see below) receive detailed feedback. For accepted manuscripts, HER also has a unique feedback process called casting whereby two editors carefully read a manuscript and offer overarching suggestions to strengthen and clarify the argument.

Question: “What is a Voices piece and how does it differ from an essay?”

Answer: Voices pieces are first-person reflections about an education-related topic rather than empirical or theoretical essays. Our strongest pieces have often come from educators and policy makers who draw on their personal experiences in the education field. Although they may not present data or generate theory, Voices pieces should still advance a cogent argument, drawing on appropriate literature to support any claims asserted. For examples of Voices pieces, please see Alvarez et al. (2021) and Snow (2021).

Question: “Does HER accept Book Note or book review submissions?”

Answer: No, all Book Notes are written internally by members of the Editorial Board.

Question: “If I want to submit a book for review consideration, who do I contact?”

Answer: Please send details about your book to the Content Editor at [email protected].

Manuscript Formatting

Question: “the submission guidelines state that manuscripts should be a maximum of 9,000 words – including abstract, appendices, and references. is this applicable only for research articles, or should the word count limit be followed for other manuscripts, such as essays”.

Answer: The 9,000-word limit is the same for all categories of manuscripts.

Question: “We are trying to figure out the best way to mask our names in the references. Is it OK if we do not cite any of our references in the reference list? Our names have been removed in the in-text citations. We just cite Author (date).”

Answer: Any references that identify the author/s in the text must be masked or made anonymous (e.g., instead of citing “Field & Bloom, 2007,” cite “Author/s, 2007”). For the reference list, place the citations alphabetically as “Author/s. (2007)” You can also indicate that details are omitted for blind review. Articles can also be blinded effectively by use of the third person in the manuscript. For example, rather than “in an earlier article, we showed that” substitute something like “as has been shown in Field & Bloom, 2007.” In this case, there is no need to mask the reference in the list. Please do not submit a title page as part of your manuscript. We will capture the contact information and any author statement about the fit and scope of the work in the submission form. Finally, please save the uploaded manuscript as the title of the manuscript and do not include the author/s name/s.

Invitations

Question: “can i be invited to submit a manuscript how”.

Answer: If you think your manuscript is a strong fit for HER, we welcome a request for invitation. Invited manuscripts receive one round of feedback from Editors before the piece enters the formal review process. To submit information about your manuscript, please complete the Invitation Request Form . Please provide as many details as possible. The decision to invite a manuscript largely depends on the capacity of current Board members and on how closely the proposed manuscript reflects HER publication scope and criteria. Once you submit the form, We hope to update you in about 2–3 weeks, and will let you know whether there are Editors who are available to invite the manuscript.

Review Timeline

Question: “who reviews manuscripts”.

Answer: All manuscripts are reviewed by the Editorial Board composed of doctoral students at Harvard University.

Question: “What is the HER evaluation process as a student-run journal?”

Answer: HER does not utilize the traditional external peer review process and instead has an internal, two-stage review procedure.

Upon submission, every manuscript receives a preliminary assessment by the Content Editor to confirm that the formatting requirements have been carefully followed in preparation of the manuscript, and that the manuscript is in accord with the scope and aim of the journal. The manuscript then formally enters the review process.

In the first stage of review, all manuscripts are read by a minimum of two Editorial Board members. During the second stage of review, manuscripts are read by the full Editorial Board at a weekly meeting.

Question: “How long after submission can I expect a decision on my manuscript?”

Answer: It usually takes 6 to 10 weeks for a manuscript to complete the first stage of review and an additional 12 weeks for a manuscript to complete the second stage. Due to time constraints and the large volume of manuscripts received, HER only provides detailed comments on manuscripts that complete the second stage of review.

Question: “How soon are accepted pieces published?”

Answer: The date of publication depends entirely on how many manuscripts are already in the queue for an issue. Typically, however, it takes about 6 months post-acceptance for a piece to be published.

Submission Process

Question: “how do i submit a manuscript for publication in her”.

Answer: Manuscripts are submitted through HER’s Submittable platform, accessible here. All first-time submitters must create an account to access the platform. You can find details on our submission guidelines on our Submissions page.

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Assessing educational inequality in high participation systems: the role of educational expansion and skills diffusion in comparative perspective

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A vast literature shows parental education significantly affects children’s chance of attaining higher education even in high participation systems (HPS). Comparative studies further argue that the strength of this intergenerational transmission of education varies across countries. However, the mechanisms behind this cross-national heterogeneity remain elusive. Extending recent arguments on the “EE-SD model” and using the OECD data for over 32,000 individuals in 26 countries, this study examines how the degree of educational inequality varies depending on the levels of educational expansion and skills diffusion. Country-specific analyses initially confirm the substantial link between parental and children’s educational attainment in all HPS. Nevertheless, multilevel regressions reveal that this unequal structure becomes weak in highly skilled societies net of quantity of higher education opportunities. Although further examination is necessary to establish causality, these results suggest that the accumulation of high skills in a society plays a role in mitigating intergenerational transmission of education. Potential mechanisms include (1) skills-based rewards allocation is fostered and (2) the comparative advantage of having educated parents in the human capital formation process diminishes due to the diffusion of high skills among the population across social strata. These findings also indicate that contradictory evidence on the persistence of educational inequality in relation to educational expansion may partially reflect the extent to which each study incorporates the skills dimension. Examining the roles of societal-level skills diffusion alongside higher education proliferation is essential to better understand social inequality and stratification mechanisms in HPS.

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Introduction

Access to higher education has markedly increased over the past decades, leading to the establishment of high participation systems (HPS) worldwide (Cantwell et al., 2018 ). Despite such an expansion of higher education opportunities, evidence shows that one’s educational attainment is unequally distributed based on socio-economic status (SES) (Marginson, 2016a , 2016b ; Pfeffer, 2008 ; Voss et al., 2022 ). This persistent association between SES and education is often explained through the lens of stratification theories, such as maximally maintained inequality (Raftery & Hout, 1993 ) and effectively maintained inequality (Lucas, 2001 ). Comparative studies also highlight the influence of societal conditions, suggesting that highly tracked education systems are likely to exacerbate educational inequalities despite facilitating smoother transitions from education to work (Bol et al., 2019 ; Burger, 2016 ; Österman, 2018 ; Reichelt et al., 2019 ; Traini, 2022 ).

Although researchers have extensively investigated the unequal structure of educational attainment from longitudinal and cross-national perspectives, the mechanisms behind the heterogeneous degrees of inequality across societies remain elusive. As mentioned, educational tracking has been seen as a key societal determinant. However, OECD ( 2018 ) reveals that the magnitude of SES significantly varies even among HPS with similar levels of tracking and higher education expansion. This suggests there are missing societal traits, not yet explored in prior studies, that explain cross-national variation in the extent of educational inequality. Identifying this “hidden” structure would also be valuable from a policy perspective in addressing unequal educational attainment in HPS.

In this regard, recent research has detected a unique social structure: (1) the expansion of higher education (i.e., educational expansion) is not identical to the accumulation of high skills (i.e., skills diffusion) and (2) these two societal dimensions play distinct roles in social stratification by influencing the amount and allocation of human capital and socio-economic rewards (Araki, 2020 ; Araki & Kariya, 2022 ; Hanushek & Woessmann, 2015 ). 1 Drawing on these findings, Araki ( 2023b ) proposed the “EE-SD model” to uncover the characteristics of higher education systems and relevant social problems. This framework, with close attention to skills alongside education per se, potentially offers a useful viewpoint to better understand educational stratification in HPS for two reasons.

First, given that high-SES families tend to transmit their high educational attainment via human capital development of offsprings in terms of high skills and aspirations (Davies et al., 2014 ), this relative advantage may weaken due to skills diffusion insofar as this societal shift occurs in a way that promotes the share of the population possessing high skills across social strata including the disadvantaged. This also means, so long as skills diffusion is realized exclusively among the advantaged without involving their low-SES counterparts, the degree of educational inequality may even intensify due to the exacerbated advantage of the high-SES group in human capital formation.

Second, in case skills diffusion promotes a more meritocratic rewards allocation process based on increased visibility of skills (Araki, 2020 ), it is plausible that the relative impact of family background on educational attainment diminishes while the importance of skills as such increases. Put differently, if HPS are formed merely as a consequence of expanding educational opportunities without skills diffusion, the advantaged may retain their prestigious positions on the education ladder regardless of their skills level. Furthermore, considering a possibility that the accumulation of high skills in a society does not make skills more visible, skills diffusion may not affect the structure of educational inequality due to the absence of skills-based meritocratic system. In either case, the association between intergenerational transmission of higher education and societal-level skills diffusion represents an essential knowledge gap in this vein.

From a comparative perspective, this paper thus examines how the linkage between SES and college completion varies across societies depending on the degree of skills diffusion, as well as higher education expansion and tracking. In what follows, the relevant literature is reviewed, followed by data/methods, analysis results, and discussion.

Inequality in educational attainment

In analyzing the association between individuals’ SES and educational attainment, scholars have long paid attention to how it shifts in tandem with educational expansion (Breen, 2010 ; Shavit et al., 1993 ). This agenda is particularly relevant in the contemporary world, many parts of which have achieved HPS with tertiary enrolment ratios exceeding 50% (Cantwell et al., 2018 ; Marginson, 2016a ).

One oft-cited concept in this line of research is maximally maintained inequality (MMI) proposed by Raftery and Hout ( 1993 ), although their primary focus was on secondary rather than tertiary education. Uncovering that the contribution of social origin to children’s education persisted despite increased educational opportunities in Ireland, they argued intergenerational inequality would only begin to decline once the advantaged reached a saturation point (e.g., 100% of enrolment). Subsequent studies have widely confirmed this MMI structure at the tertiary education level (Bar Haim & Shavit, 2013 ; Chesters & Watson, 2013 ; Czarnecki, 2018 ; Konstantinovskiy, 2017 ; Wakeling & Laurison, 2017 ).

Extending MMI, Lucas ( 2001 ) found that inequality had been effectively maintained, as advantaged individuals would secure valuable educational assets (e.g., prestigious institutions and fields of study) even when the disadvantaged caught up in terms of the level of educational qualifications. A vast literature has empirically supported the idea of effectively maintained inequality (EMI) in the higher education sector across the globe (Ayalon & Yogev, 2005 ; Boliver, 2011 ; Dias Lopes, 2020 ; Ding et al., 2021 ; Gerber & Cheung, 2008 ; Hällsten & Thaning, 2018 ; Kopycka, 2021 ; Reimer & Pollak, 2010 ; Seehuus, 2019 ; Torche, 2011 ; Triventi, 2013 ).

Meanwhile, introducing a standardized analytical model, Breen et al. ( 2009 ) argued that the link between origins and educational attainment weakened along with educational expansion in multiple countries. Much research reports a similar structure of nonpersistent inequality (Barone & Ruggera, 2018 ; Breen, 2010 ; Breen et al., 2010 ; Duru-Bellat & Kieffer, 2000 ; Pfeffer & Hertel, 2015 ). In line with these longitudinal findings, comparative work also detected the smaller social gap in education in societies with a larger share of highly educated populations, despite the observed MMI structure in each country (Liu et al., 2016 ).

In investigating the mechanisms behind cross-national variation in the SES effect on educational attainment, scholars have shed light on institutional stratification in education (Pfeffer, 2008 ). Evidence shows that (1) highly tracked systems make education-work transitions more effective (i.e., learners gain occupation-specific skills or at least educational credentials signifying those skills, thus obtaining occupations relevant to their fields of study) (Bol et al., 2019 ) but (2) strong tracking also intensifies educational inequality compared to more comprehensive education systems (Bol and van de Werfhorst, 2013 ; Burger, 2016 ; Chmielewski et al., 2013 ; Österman, 2018 ; Reichelt et al., 2019 ; Tieben & Wolbers, 2010 ; Van de Werfhorst, 2018 ; Van de Werfhorst and Mijs, 2010 ).

The link between SES and educational attainment has thus been uncovered in relation to societal-level educational expansion and tracking. Nonetheless, one puzzling fact is that the degree of inequality significantly varies even among HPS with similar social policies and education systems (OECD, 2018 ). It is plausible that some societal traits, which have been inadequately incorporated in prior studies, operate in forming educational inequality.

As argued, one potentially important process here is skills diffusion. Evidence shows (1) the degree of skills diffusion is positively correlated with that of educational expansion, making HPS more likely to advance skills diffusion (Araki, 2023b ) but (2) the effects of educational expansion and skills diffusion on socio-economic outcomes at the individual and societal levels are not identical (Araki, 2020 ; Hanushek & Woessmann, 2015 ). Given these arguments, one may assume that the accumulation of high skills in a society, apart from educational proliferation, plays a unique role in forming educational (in)equality especially via two possible mechanisms.

First, prior research argues that skills diffusion may accelerate the skills-based rewards distribution because of increased discernability of high skills, which allows the labor market to identify highly skilled human resources (Araki, 2020 ). Should this intensified meritocratic mechanism induced by skills diffusion be applicable to the schooling process, the impact of SES on educational attainment may diminish in contrast to the growing importance of high skills. Nonetheless, evidence is elusive concerning the extent to which skills diffusion actually increases skills’ visibility in such a way that educational assets are allocated based on skills instead of SES. Put differently, it is still possible that the structure of educational inequality is not affected, or rather exacerbated, by skills diffusion.

Second, the accumulation of high skills, especially among the disadvantaged, may mitigate the comparative advantage of high-SES groups in human capital formation. Considering that the advantaged are more likely to invest their resources to foster children’s skills, which are favored in the process of climbing the educational ladder, the effects of such interventions could be hindered by skills development among the disadvantaged group. One should note, despite this potential consequence of skills diffusion, SES may still exert its influence on education by exerting symbolic power in that children from advantaged families easily internalize legitimate culture and behaviors leading to better educational outcomes (Jæger & Karlson, 2018 ; Sieben & Lechner, 2019 ). In addition, in response to the catchup by low-SES groups, their high-SES counterparts may invest more to further enhance children’s skills both quantitatively and qualitatively (i.e., the level and type of skills, respectively). This perception is aligned with EMI theory on educational inequality.

Nevertheless, the SES gap incurred by unequal human capital formation could still diminish in association with skills diffusion. For example, Huber, Gunderson, and Stephens ( 2020 ) found that the skills development mechanism played a role in reducing inequalities, although their focus was on educational spending and income inequality. Should this be the case for the distribution of higher education opportunities, it is logical to assume that the cross-national variation in the linkage between SES and educational attainment can be explained partially, if not completely, by the extent of skills diffusion in each society. Indeed, while showing the typological EE-SD framework, Araki ( 2023b ) argued that the structure of educational inequality would be an important agenda to be examined by incorporating both educational expansion and skills diffusion. Therefore, the current study investigates the heterogeneous SES effect on higher education attainment with particular attention to societal-level skills diffusion, educational expansion, and tracking.

Data and methods

Data and strategy.

The degree of skills diffusion has long been unmeasurable in a comparable way. However, the Organisation for Economic Co-operation and Development (OECD) has recently developed an international survey of adult skills (PIAAC), which permits a cross-national examination of cognitive skills. Although using this dataset merely covers OECD and partner countries, future research can use the framework and findings that follow as the foundation to investigate broader geographical areas.

PIAAC is composed of a standardized assessment of cognitive ability and background questionnaires including educational attainment and socio-demographic attributes. Participants are nationally representative individuals aged 16 to 65 and accordingly, one can infer the skills level of the population based on individual-level data (OECD, 2019 ). Because of its wide coverage of variables and high quality skills data, PIAAC has been used by the vast literature on educational inequality and socio-economic returns to education (Araki, 2020 , 2023a ; Hanushek et al., 2015 ; Heisig et al., 2020 ; Huber et al., 2020 ; Jerrim & Macmillan, 2015 ; Pensiero & Barone, 2024 ). One limitation of PIAAC is its scope: while it primarily assesses cognitive ability in terms of literacy and numeracy, 2 other types (e.g., noncognitive and occupation-specific skills) are not directly included. However, given that cognitive skills serve as the basis for other dimensions of skills and socio-economic outcomes (Krishnakumar & Nogales, 2020 ; OECD, 2016 ), it is sensible to use the PIAAC data to quantify the skills level.

Among PIAAC participants aged 16 to 65, this article focuses on respondents aged 25 to 34, considering that the association between SES and education could significantly vary across cohorts. This approach also reduces two risks: (1) as compared to younger groups, respondents are likely to have completed the highest level of education; and (2) unlike older groups, the influence of work experience and relevant attributes on educational attainment is assumed to be small. From the OECD public use database, 3 the current study extracts 32,549 respondents in 26 countries that provide valid data for all predictor and outcome variables as detailed below. See Table 1 for specific countries and the sample size with the gross tertiary enrolment ratio, which indicates that all countries are classifiable as HPS (i.e., over 50%).

One potential analytic approach here is to focus on how the contribution of SES to educational attainment has shifted over time in the process of educational expansion and skills diffusion in a given society. As reviewed, much research in this vein has employed a longitudinal approach to compare multiple cohorts within countries. Although this method gives detailed implications for each society, it does not completely address period effects (Glenn, 1976 ). In addition, because the strength of tracking is relatively stable (Brunello & Checchi, 2007 ), it is difficult to accurately detect the longitudinal change.

Two types of cross-country analyses thus become sound strategies. The first approach is to perform country-specific analyses using the individual-level data and to contrast the relative degree of educational inequality and societal-level degrees of educational expansion, skills diffusion, and tracking across cases. The second strategy is to employ hierarchical modeling with pooled data from all countries with both individual and country-level variables. While the first method provides evidence for each society, the second one shows the general tendency beyond the national boundary. Given the comparative advantage of these two options, both approaches are employed: (1) country-specific analyses using individual-level data in 26 countries and (2) multilevel regressions focused on the link between the strength of educational inequality and societal-level conditions.

The outcome variable is the possession of a bachelor’s degree or above, which is equivalent to the International Standard Classification of Education (ISCED) 2011 Level 6 and above. Although short-cycle tertiary education (ISCED 2011 Level 5) is sometimes included when assessing individuals’ educational attainment, the nature of this educational stage varies across countries (Di Stasio, 2017 ). To ensure international comparability, the current paper employs ISCED 2011 Level 6 and above as a measure for high educational attainment. Considering also (1) the potential bias incurred by using a categorical measure in hierarchical modeling and (2) the different nature between the possession of tertiary degrees and the length of educational experience, a continuous variable (i.e., years of schooling) is also adopted. Because one country does not provide data on this continuous measure, the nonlinear model (with the dummy for ISCED 2011 Level 6 and above) is primarily shown in the manuscript, while the linear model (with years of schooling as an outcome) is displayed as a robustness check (see the next section for more details).

As regards individual-level predictor variables, much research has used parental education, occupation, and economic status, as well as the number of books in the home (NBH). Among these, the PIAAC dataset includes parental education (i.e., father’s and mother’s highest levels of education) and NBH. Although NBH has been widely taken as a representative SES measure (Chmielewski, 2019 ; OECD, 2016 ; Sieben & Lechner, 2019 ), recent research points out its potential endogeneity problem especially when the respondents are children (Engzell, 2021 ). Considering also the meaning/value of NBH substantially varies across countries, the current study uses parental education to represent SES. This strategy focused on parental education is widely employed by the literature in this vein (Brand & Xie, 2010 ; Cheng et al., 2021 ; Oh & Kim, 2020 ; Pensiero & Barone, 2024 ; Torche, 2018 ). Following prior studies, three categories are constructed by combining paternal and maternal education (i.e., both parents, one parent, or neither parents are tertiary educated). Meanwhile, a robustness check is performed by replacing parental education with NBH, and the result is shown in the Appendix (Table 5 ). Note that the result of this supplementary analysis is consistent with the main findings that follow. Alongside parental education, individual-level predictors include gender (men dummy), age (30–34-year-old dummy), 4 and immigrant background (first-generation immigrant dummy) as these attributes are substantially associated with educational attainment (Breen & Jonsson, 2005 ).

Country-level variables cover the levels of educational expansion, skills diffusion, and tracking. To align with the outcome variable, the education measure is the percentage of the population who possess a bachelor’s degree and above. Considering the potential bias caused by using the simple means of individual-level education and skills in the PIAAC dataset for macro-level indicators, the societal-level variables here are not estimated based on PIAAC micro data but extracted from the national statistics in each country (OECD, 2014 ). It is noteworthy that the following results and implications are robust even when replacing this societal trait with the proportion of people with a degree including ISCED 2011 Level 5 (short-cycle tertiary) (see Table 6 in the Appendix).

For the skills indicator, following previous research (Araki, 2020 , 2023c ), the proportion of individuals whose mean score of literacy and numeracy in PIAAC is 326 and above (out of 500 points) is used. This is consistent with the OECD’s definition of high skills (OECD, 2019 ). As discussed, “skills” directly assessed by PIAAC refer to cognitive ability, and therefore, future research must incorporate other dimensions to advance this line of studies. These macro-level education and skills metrics are limited to the population aged 25 to 34 in line with individual-level variables. This way, the marginal distribution of educational opportunities and skills among the target age group is properly incorporated in the following analyses. Note that this measure reflects the skills level among the population ages 25–34, and hence, it is suitable to test one of the said two hypothetical mechanisms: a more meritocratic rewards allocation process is intensified by skills diffusion, leading to less educational inequality. Meanwhile, the percentage of people with high skills among those whose parents are not tertiary educated is also used to examine the second scenario: the larger share of highly skilled people among low-SES groups undermines the comparative advantage of high-SES groups in human capital formation. This skills indicator for the low parental education group is estimated by the OECD using all participants in each country and not limited to those aged 25 to 34. The analysis results of this second approach are thus shown in the Appendix (Table 6 ).

The degree of tracking is derived from Bol and van de Werfhorst ( 2013 ). Admittedly, other conditions could also affect the association between parental education and educational attainment against a background of skills diffusion and educational expansion. In particular, the macroeconomic structure may alter the social function of skills and higher education, while the overall degree of social inequality may influence educational inequality. Although the aforementioned three societal-level traits are primarily used given the potential bias incurred by a larger number of macro-level measures against the relatively small sample size for countries, GDP per capita and the Gini index are therefore added to the main analysis for a robustness check (see the Appendix, Table 6 ). Table 2 summarizes descriptive statistics.

Analytic models

For country-specific analyses, binary logistic regression is performed using individual-level data for 26 countries respectively as follows.

where i = individual, p i = the probability of holding a bachelor’s degree or above for individual i , b n = the coefficient of predictor variables, M i = the men dummy, A i = the age 30–34 dummy, I i = the first-generation immigrant dummy, BT i = the dummy for those whose parents are both tertiary educated, OT i = the dummy for those having one tertiary educated parent, and ε i = the residual for individual i . The primary focus here is on the parameters for parental education ( b 4 and b 5 ). Given that these coefficients do not provide straightforward implications (Breen et al., 2018 ; Mood, 2010 ), the average marginal effects (i.e., predicted probability for each parental education group) are also estimated and compared across countries to confirm the variation in the advantage of having tertiary educated parents (see Fig. 1 ). This serves as the basis for the following multilevel regressions.

In model 1 of hierarchical modeling, only individual-level predictors are employed with particular attention to b 4 , and b 5 in Eq. ( 2 ), where j = level two (i.e., country).

In models 2 to 4, three country-level variables and their interactions with two individual-level parental groups are added to model 1, respectively, to examine how the association between parental education and educational attainment varies in accordance with the societal conditions. Although there is a risk of biased estimation by including more than two level-two variables given the limited number of countries in the current model, model 5 concurrently incorporates the extent of educational expansion, skills diffusion, and tracking to confirm the robustness of models 2 to 4. GDP per capita and the Gini index are further added for robustness checks (see Table 6  in the Appendix). The basic concepts of these models are describable as follows.

where γ 00 = the average intercept, γ 0n = the coefficient of country-level predictor variables X , and u 0 j = the country ( j )-dependent deviation. Substituting Eq. ( 3 ) into Eq. ( 2 ) and denoting b n by γ n 0 while incorporating cross-level interaction terms, γ 4 n and γ 5 n in Eq. ( 4 ) below indicate the heterogeneous magnitudes of two parental education measures associated with three societal traits. Following the recent argument that random slopes on lower-level variables used in cross-level interactions should be incorporated (Heisig & Schaeffer, 2019 ), both random intercepts and slopes are estimated for parental education as follows.

where u nj = the country dependent deviation of the slopes for two parental education groups. Finally, as shown in Eq. ( 5 ) where Y ij is years of schooling for individual i in country j , model 6 employs a multilevel linear regression approach with the same predictors as model 5 for a robustness check.

Note that these cross-sectional models do not completely account for unobserved variables at the individual and societal levels. As the OECD has been administering the second cycle of PIAAC, future research must undertake longitudinal analyses to address this issue.

Table 3 shows the results of binary logistic regression of college completion for 26 countries. In all cases, parental education exhibits a positive sign for the chance of attaining tertiary education (i.e., b 4 and b 5 in Eq. 1 are positive and statistically significant). 5 In particular, the magnitude is notably large for the most advantaged group with both parents being tertiary educated (e.g., b 4 = 1.02, 95%CI 0.63 to 1.41; b 5 = 1.92, 95%CI 1.43 to 2.42 in Austria). Figure 1 indeed indicates that the predicted probability of obtaining a first degree substantially varies across three parental education groups, with the most disadvantaged tier (i.e., without tertiary educated parents) suffering from a limited chance of completing tertiary education in every country.

Predicted probability of completing tertiary education by parental education in 26 countries. The Y axis indicates the predicted probability of attaining tertiary education (ISCED 2011 level 6 or above) for three parental education groups as indicated at the top of the figure across 26 countries ( X axis). See also Table 1 for country abbreviations

Nonetheless, it is worth noting that despite the relative disadvantage within a country, the predicted probability of college completion among the low parental education group in some countries (e.g., 37.6%, 95%CI 33.9 to 41.3 in Finland) is higher than that of the second tier with one tertiary educated parent in others (e.g., 29.8%, 95%CI 22.7 to 36.9, in Belgium). In addition, as far as the extent of educational inequality is concerned, the gap in the chance of college completion between the most advantaged and disadvantaged groups differs across nations, ranging from 28.8 points in South Korea to 76.6 points in Turkey. The key question here is how this cross-national variation in intergenerational transmission of higher education is associated with societal-level conditions.

Table 4 summarizes the results of multilevel regressions. In model 1 with only individual-level variables, all predictors show a significant sign for educational attainment at the 0.1% level. That is, even when accounting for gender, age, and immigrant background, as well as cross-national differences in the intercept and slopes, the strong association between parental education and educational attainment is confirmed. As observed earlier in the country-specific analyses, the magnitude of having two tertiary educated parents is larger than that of only one highly educated parent ( γ 40 = 1.91, 95%CI 1.73 to 2.08; γ 50 = 1.08, 95%CI 0.95 to 1.21). This substantial linkage between parental education, especially having two tertiary educated parents, and the chance of college completion holds regardless of models in the following analyses.

Model 2 adds one country-level variable (i.e., the proportion of tertiary educated people) and its cross-level interactions with two measures for parental education. Apart from the significant coefficients of individual-level predictors, the interaction terms between parental education and the degree of educational expansion shows negative and statistically significant signs ( γ 41 = −0.02, 95%CI −0.04 to 0.00, P = 0.022; γ 51 = −0.02, 95%CI −0.04 to −0.01, P = 0.006). This suggests, as argued by some prior studies, the advantage of having tertiary educated parents is likely to be smaller in societies where the aggregate education level is relatively high. Put differently, although further longitudinal investigations are necessary to establish causality, the accumulation of educational opportunities in a society might operate as an equalizer in mitigating the influence of parental education.

An identical structure is observed in model 3, where the degree of educational expansion is replaced with that of skills diffusion (i.e., the proportion of highly skilled people). In addition to the significant links between individual-level predictors and the probability of obtaining a first degree, the coefficient of the interaction terms between parental education and the societal-level skills indicator is negative ( γ 42 = −0.03, 95%CI −0.05 to −0.01, P = 0.003; γ 52 = −0.03, 95%CI −0.05 to −0.02, P < 0.001). As with the extent of educational expansion, this result indicates a possibility that the role of parental education in children’s educational attainment could decline in societies with a higher degree of skills diffusion. In Model 4, the strength of tracking is included instead of societal-level education and skills measures. As reported by previous research in this vein, the positive signs of interaction terms between tracking and parental education are confirmed ( γ 43 = 0.15, 95%CI −0.02 to 0.31, P = 0.088; γ 53 = 0.15, 95%CI 0.04 to 0.27, P = 0.007). That is, the extent of intergenerational educational inequality is likely to be stronger in more tracked systems.

Model 5 incorporates all three country-level predictors and their interaction terms. One important result here is that the interaction between parental education and the degree of educational expansion is almost nullified ( γ 41 = −0.00, 95%CI −0.03 to 0.02, P = 0.773; γ 51 = 0.01, 95%CI −0.01 to 0.02, P = 0.326). In contrast, the one between parental education and the skills diffusion measure holds its negative sign ( γ 42 = −0.03, 95%CI −0.05 to −0.00, P = 0.030; γ 52 = −0.03, 95%CI −0.05 to −0.02, P < 0.001). The same structure is observed when (1) conducting multilevel linear regression with years of schooling as the outcome in Model 6 ( γ 41 = −0.04, P = 0.133; γ 51 = −0.01, P = 0.453; γ 42 = −0.04, P = 0.072; γ 52 = −0.05, P = 0.001), (2) incorporating the proportion of people with short-cycle tertiary education for the educational expansion metric in Model A2 ( γ 42 = −0.02, 95%CI −0.04 to 0.00, P = 0.034; γ 52 = −0.03, 95%CI −0.04 to −0.02, P < 0.001), and (3) adjusting for GDP per capita and the Gini index as additional societal-level conditions in Model A3 ( γ 42 = −0.03, 95%CI −0.06 to 0.00, P = 0.059; γ 52 = −0.03, 95%CI −0.04 to −0.01, P < 0.001). Figure 2 indeed depicts the diminishing effect of parental education in tandem with higher proportions of the population with high skills.

Marginal effects of parental education by the degree of skill diffusion. The Y axis is the marginal effects of parental education (i.e., one parent is tertiary educated; both parents are tertiary educated) across the degree of skills diffusion (i.e., the percentage of population with high skills) ranging from 0 to 50 ( X axis) based on the multilevel binary logistic regression (model 5). The dashed lines indicate the 95% confidence intervals

The sole exception is the final model using the share of highly skilled people among the low parental education group as the societal-level skills measure (Model A4 in the Appendix, Table 6 ). While its interaction with the second tier (i.e., only one tertiary educated parent) shows a substantially negative coefficient ( γ 52 = −0.02, 95%CI −0.04 to −0.01, P = 0.001), the one with the top tier (i.e., both parents are tertiary educated) is not statistically significant despite its negative sign ( γ 42 = −0.02, 95%CI −0.04 to −0.00, P = 0.106). This suggests that the second hypothetical scenario (i.e., the advantage of high-SES groups in human capital formation diminishes along with skills diffusion among the disadvantaged) is partially supported in that the second layer in parental education with one tertiary educated parent encounters their diminishing advantage in educational attainment. However, the most advantaged group seems to retain their relative position even when the disadvantaged advances their cognitive skills. In the next section, after summarizing the key findings, some implications are discussed.

Discussion and conclusion

This study investigates cross-national variation in intergenerational transmission of education among high participation systems (HPS). Drawing on the EE-SD framework (Araki, 2023b ), particular attention is paid to societal-level higher education expansion, tracking, and skills diffusion. Using the OECD PIAAC data for 32,549 adults in 26 countries, individual-level analyses first corroborate the literature in that parental education is significantly associated with the likelihood of college completion. However, multilevel regressions show that educational inequality is not persistent; rather, the advantage of having tertiary educated parents becomes smaller in societies with a higher proportion of tertiary graduates. This result supports prior evidence indicating the equalizing function of educational expansion.

Nevertheless, once incorporating the degrees of skills diffusion and tracking as societal-level predictors, the interaction between the extent of educational expansion and parental education loses its significant sign. Instead, the skills indicator holds a negative interaction effect with parental education. Further research is necessary to claim causation, given that (1) unobserved societal traits may be significantly affecting the link between parental education and the societal-level education/skills indicators and (2) the degree of skills diffusion may mediate the effect of educational expansion as detailed below. Yet, based on these results, it is plausible that the accumulation of high skills in a society plays a role in altering the power of parental education over children’s chance of attaining higher education.

Assuming that the observed results reflect a causal relationship to a certain extent, they are interpretable as representing distinct functions of educational expansion and skills diffusion. When focusing solely on the proliferation of educational opportunities (as in model 2), growth in higher education appears to operate as an equalizer and mitigates intergenerational transmission of higher education. However, because educational expansion and skills diffusion often advance hand in hand (Araki, 2023b ), the seemingly equalizing effect of educational expansion might actually be attributed to the contribution of skills diffusion. Consequently, the observed effect of educational proliferation can be cancelled out once the skills dimension is taken into account. Importantly, this does not necessarily mean that educational expansion is irrelevant to the heterogeneous link between parental education and children’s educational attainment, as skills diffusion may mediate the contribution of increased higher education opportunities. That is, educational expansion may indirectly reduce educational inequality via fostering high skills. Nonetheless, regardless of the extent to which skills diffusion incorporates the influence of educational proliferation, it is noteworthy that the accumulation of high skills itself is substantially associated with the degree of educational inequality.

As regards the potential mechanism whereby skills diffusion may curb intergenerational transmission of education, one must recognize the qualitative difference between two societal conditions. While educational expansion means the larger number/share of the population with a tertiary degree as such regardless of their actual skills, skills diffusion represents the accumulation of individuals with high skills in a society. Accordingly, the level of skills diffusion can signify the quantity of human resources possessing adequate abilities to make rational choices and contribute to a more meritocratic society, where educational and other assets may be allocated based on individuals’ merit rather than SES. This perception aligns with prior studies that have demonstrated the distinct roles of skills in the rewards allocation process (Araki & Kariya, 2022 ; Hanushek et al., 2015 ). Importantly, this diminishing inequality cannot be observed solely through educational expansion, as it does not guarantee a sufficient number of individuals with high skills who can effectively promote the establishment of a meritocratic mechanism. 6

Should this be the case, the extent of intergenerational transmission of education is likely to diminish especially when skills diffusion occurs among low-SES groups. This is because the accumulation of high skills among the disadvantaged undermines the relative advantage of high-SES groups (e.g., those with tertiary educated parents in the current analysis) in the human capital formation process, which in turn affects their chance of college completion. Notwithstanding, the empirical findings (model A4 in the Appendix, Table 6 ) only partially support this hypothesis. In tandem with the higher proportion of high skills among the disadvantaged whose parents are not tertiary educated, the advantage of having one tertiary educated parent declines. However, the advantageous position of having both a tertiary educated mother and father is not significantly devalued despite the negative sign. This suggests that the catching-up effect of advancing cognitive skills among the disadvantaged is more likely to be observable against the second tier of parental education strata, whereas the most advantaged group may maintain their higher chance of college completion, at least in the initial stage. These trends, which demonstrate persistent and flexible advantages among the socially privileged, are consistent with MMI (Raftery & Hout, 1993 ) and EMI (Lucas, 2001 ). If in fact this partial equalizing effect of skills diffusion exists, it raises an important question: will further advancement of skills development among the disadvantaged eventually mitigate the advantageous position of the top tier? In particular, from the EMI perspective, it is worth exploring whether the advantaged group will maintain their superiority by targeting certain fields of study favored in the labor market, particular higher education institutions with high prestige, and/or further advanced degrees (e.g., master’s and doctoral levels). Longitudinal studies are essential to answer these questions.

As such, one can better understand cross-national variation in educational inequality by shedding light on the diffusion of high skills, as well as higher education. This also suggests that the contradictory views on the effect of educational expansion in the literature (i.e., persistent versus nonpersistent inequality) may partially reflect the extent to which each study incorporates the influence of skills diffusion. When analyzing the consequences of increased educational opportunities, research may find a declining contribution of SES to educational attainment so long as educational proliferation in the target case is accompanied by skills diffusion (i.e., when trends in aggregate levels of education and skills are aligned). In contrast, if one focuses on societies (or periods/cohorts) where these two societal traits are significantly decoupled and educational opportunities increase without corresponding skills diffusion, the unequal structure is likely to persist because the equalizing role of skills diffusion is absent.

Nevertheless, the current paper adopts a cross-country approach unlike much research in this vein. Therefore, further examination is imperative to conclude whether, to what extent, and how skills diffusion actually operates as a fundamental societal trait. First, country-specific longitudinal analyses are pivotal to detect causal relationships across SES, higher education attainment, skills diffusion, and other factors. Second, in addition to the retrospective approach used in this paper, prospective analyses are essential lest we overrate the degree of intergenerational inequality (Breen & Ermisch, 2017 ; Lawrence & Breen, 2016 ; Song & Mare, 2015 ). Third, variables should be extended for family background (e.g., parental skills, occupations, and income), educational outcomes (e.g., aspiration, completion, fields of study, and prestige of institutions), skills (e.g., noncognitive and occupation-specific skills), and societal conditions (e.g., labor and welfare policy). Because the values of specific types of educational credentials and skills may differ in accordance with macroeconomic and socio-cultural settings, interactional effects of these variables need to be carefully examined. Likewise, given that the metrics for individual-level education and skills and societal-level educational expansion and skills diffusion are closely linked in the current study (and thus estimation could be somewhat biased), future research must incorporate different types of education and skills measures at the individual and societal levels. Fourth, as an extension of this line of studies, one should investigate how the trend of educational expansion and skills diffusion affect not only educational attainment but also (in)equalities in socio-economic outcomes beyond the schooling stage. This is particularly important as recent research shows that educational equalization does not necessarily result in the weakening linkage between parental education and children’s earnings over time, except Scandinavian countries (Pensiero & Barone, 2024 ). Finally, in addressing these tasks, analyses of non-OECD and non-HPS cases would be useful to obtain insights from a comparative perspective.

With this potential for further development, the present study contributes to advancing our knowledge on educational inequality among HPS. It is particularly noteworthy that the accumulation of high skills, along with the expansion of higher education opportunities, may collectively operate as an equalizer and mitigates intergenerational inequality in educational attainment.

Terms “educational expansion” and “skills diffusion” imply longitudinal changes in a given society, that is, an increase in the number/share of individuals with higher levels of educational attainment and skills, respectively. Meanwhile, macro-level data in the following empirical analyses are collected at one point in time. Therefore, the “levels of education/skills” are used in some of the empirical part, but the terms “educational expansion” and “skills diffusion” are also employed unless this strategy violates the accuracy of arguments.

Although PIAAC also assesses ICT skills, this article focuses on literacy and numeracy because some countries do not provide available data on ICT skills.

See the OECD website for the PIAAC data ( https://webfs.oecd.org/piaac/puf-data/ ) [Accessed: August 1, 2023]. Some countries listed in this webpage are not included in the following analyses due to the absence of comparable data for tracking.

This dummy variable is employed instead of the continuous age measure because an ample number of respondents have only age group information in the PIAAC public-use dataset.

The analysis also reveals the nuanced function of other predictors including gender, age, and immigrant background. Although the primary focus of this article is on parental education, future research will benefit from investigating how and why the association between educational attainment and these attributes varies across societies.

Another supposition is that the accumulation of high skills merely enhances the importance of other types of family background, such as parental occupations and economic class. Should this be the case, skills diffusion does not necessarily promote a meritocratic system even though the effect of parental education per se diminishes. This is an important agenda for future research.

Data availability

Data are available from the OECD website: https://webfs.oecd.org/piaac/puf-data/

Code availability

Available upon request.

Araki, S. (2020). Educational expansion, skills diffusion, and the economic value of credentials and skills. American Sociological Review, 85 (1), 128–175. https://doi.org/10.1177/0003122419897873

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Acknowledgements

I would like to thank Takehiko Kariya, Richard Breen, Jan O. Jonsson, Herman van de Werfhorst, Cláudia Sarrico, and anonymous reviewers for their invaluable comments and suggestions.

This research is supported by the Social Sciences Internal Seed Grant Scheme, the University of Hong Kong (000250635).

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The digital transformation in pharmacy: embracing online platforms and the cosmeceutical paradigm shift

• Ahmad Almeman   ORCID: orcid.org/0000-0002-6521-9463 1  

Journal of Health, Population and Nutrition volume  43 , Article number:  60 ( 2024 ) Cite this article

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In the face of rapid technological advancement, the pharmacy sector is undergoing a significant digital transformation. This review explores the transformative impact of digitalization in the global pharmacy sector. We illustrated how advancements in technologies like artificial intelligence, blockchain, and online platforms are reshaping pharmacy services and education. The paper provides a comprehensive overview of the growth of online pharmacy platforms and the pivotal role of telepharmacy and telehealth during the COVID-19 pandemic. Additionally, it discusses the burgeoning cosmeceutical market within online pharmacies, the regulatory challenges faced globally, and the private sector’s influence on healthcare technology. Conclusively, the paper highlights future trends and technological innovations, underscoring the dynamic evolution of the pharmacy landscape in response to digital transformation.

Introduction

Digital technology is driving a massive shift in the worldwide pharmacy industry with the goal of improving productivity, efficiency, and flexibility in healthcare delivery. In the pharmacy industry, implementing digital technologies like automation, computerization, and robotics is essential to cutting expenses and enhancing service delivery​​ [ 1 ]. With a predicted 14.42% annual growth rate, the digital pharmacy market is expanding significantly and is expected to reach a market volume of about $35.33 billion by 2026. This expansion reflects the pharmacy industry’s growing reliance on and promise for digital technologies​ [ 2 ].

Pharmacy services have always been focused on face-to-face communication and paper-based procedures. However, the drive for more effective, transparent, and patient-centered healthcare is clear evidence of the growing need for digital transformation. Breakthroughs like mobile communications, cloud computing, advanced analytics, and the Internet of Things (IoT) are reshaping the healthcare sector. These breakthroughs have the potential to greatly improve patient care and service delivery, as demonstrated in other industries including banking, retail, and media [ 3 ].

In the pharmacy industry, a number of significant factors are hastening this digital transition. Important concerns include the desire for cost-effectiveness, enhanced patient care, and more transparency and efficiency in medication development and manufacture. This change has been made even more rapid by the COVID-19 pandemic, which has highlighted the necessity for digital solutions to address the difficulties associated with providing healthcare in emergency situations [ 4 ].

In terms of specific technologies being adopted, artificial intelligence (AI) and machine learning are playing a pivotal role. The McKinsey Global Institute estimates that AI in the pharmaceutical industry could generate nearly $100 billion annually across the U.S. healthcare system. The use of AI and machine learning enhances decision-making, optimizes innovation, and improves the efficiency of research and clinical trials. This results in more effective patient care and a more streamlined drug development process​ [ 5 ].

The digital transformation in the pharmacy sector represents a pivotal shift in the delivery and experience of healthcare services. This evolution is more than a transient trend; it’s a fundamental alteration in the healthcare landscape [ 6 ]. The adoption of digital technologies is reshaping aspects of healthcare, including patient engagement and medication adherence, leading to enhanced healthcare outcomes. Research indicates that digital tools in pharmacy practices have resulted in more individualized and efficient patient care. Telehealth platforms, exemplified by companies like HealthTap, are being increasingly incorporated by pharmacies to augment patient care via technological solutions. The contribution of digital health technology to medication adherence is notable, employing a variety of tools such as SMS, mobile applications, and innovative devices like virtual pillboxes and intelligent pill bottles. These advancements are pivotal in addressing the critical issue of medication nonadherence in healthcare. Furthermore, digital health tools are empowering pharmacists with expanded clinical responsibilities, particularly in the management of chronic diseases like diabetes, where apps and smart devices provide essential features such as blood glucose tracking and medication reminders. This comprehensive integration of digital health into pharmacy practice signifies a transformative era in healthcare delivery and patient management [ 7 ].

Online platforms are being used increasingly by the pharmaceutical sector and educational institutions to improve efficiency, flexibility, and accessibility. The telepharmacy program at CVS Pharmacy is an example of how telepharmacy services, which provide remote counseling and prescription verification, bring pharmaceutical care to underprivileged communities [ 8 ]. Prescription accuracy and drug management are enhanced by e-prescribing software like Epic’s MyChart and digital health apps like Medisafe [ 9 ; 10 ]. Blockchain technology is also being investigated for transparent and safe supply chain management. Continuous learning and professional networking are made possible in education by Virtual Learning Environments (VLEs) like Moodle [ 11 ], simulation software like SimMan 3G Plus [ 12 ], Continuing Professional Development (CPD) platforms like the American Pharmacists Association [ 13 ], and online conference platforms, as shown in Fig.  1 . While these platforms offer significant benefits like enhanced access and cost-effectiveness, they also present challenges, including addressing the digital divide and ensuring the quality and credibility of online services to maintain professional standards and patient safety.

In this review, we summarized the digital transformation in the pharmacy sector, emphasizing the integration of online platforms and the emerging significance of cosmeceuticals. We discussed the global shift towards digital healthcare, including telehealth and online pharmacy services, and how these changes have been accelerated by the COVID-19 pandemic. The paper also examined the impact of digital technologies on pharmacy practice and education, with a focus on telepharmacy services, e-prescribing software, and digital health apps. Additionally, it addresses the challenges and opportunities presented by this transformation, including regulatory and safety concerns, and the need for continuous professional development in the digital era.

Comprehensive overview of different platforms in the pharmaceutical industry and education illustrating purposes and exemplary cases

The global impact of online pharmacy platforms

In recent years, the landscape of pharmacy practice and education has undergone a significant transformation, driven by technological advancements and catalyzed by the global COVID-19 pandemic. A study highlighting the increasing consumer trust in online medication purchases pre, during, and post-pandemic reveals a shift in consumer behavior towards online pharmacies [ 14 ]. This trend underscores a greater reliance on these platforms, where the perceived benefits significantly outweigh the perceived risks, indicating a positive reception and growing trust in digital healthcare solutions.

The adoption of telehealth, including telepharmacy, exemplifies this shift. In the United States, patient adoption of telehealth services surged from 11% in 2019 to 46%, with healthcare providers expanding their telehealth visits [ 15 ]. This shift is a reflection of how adaptable the healthcare sector is to digital platforms and how customer acceptance is increasing. The epidemic has also served as a catalyst, hastening the creation and uptake of online telepharmacy services throughout the world. The “new normal” has forced the addition of new platforms to support established sources of health information. The creation and evaluation of an online telepharmacy service in the Philippines during the pandemic serves as an example of this, demonstrating how quickly the global pharmacy industry adopted digital solutions. These services are essential for providing and elucidating pharmaceutical information within the context of primary healthcare delivery; they are not merely supplementary [ 16 ].

Simultaneously, pharmacist-led companies such as MedEssist and MedMehave, innovated digital platforms to facilitate services like flu shots or COVID-19 tests, reflecting a move towards customer-centric, digital-first services [ 17 ]. This transition enhances convenience and access to care but also introduces significant regulatory challenges. As the growth of online medicine sales disrupts traditional pharmacy markets, navigating these challenges becomes crucial for maintaining patient safety, quality standards, and fostering a trustworthy online healthcare environment [ 18 ].

Parallel to the practice changes, educational platforms for pharmacy have also evolved, especially under the impetus of the pandemic. These platforms have integrated a mix of traditional and student-centered teaching methodologies, including remote didactic lectures and on-site experiential training. The implementation of blended learning approaches, which combine remote lectures with on-site laboratory classes, reflects a broader educational trend towards hybrid models. This approach aims to leverage the advantages of both online and traditional methods, offering a more flexible and potentially more effective educational experience [ 19 ].

It takes more than just implementing new tools to integrate educational technology into pharmacy education, it also requires understanding how these technologies affect instruction and student learning. To effectively improve the educational experience, their utilization must have a purpose. There is an increasing amount of scholarly interest in this field, as evidenced by systematic reviews of the effects of new technologies on undergraduate pharmacy teaching and learning [ 20 ]. These digital platforms will probably become more significant in the future of pharmacy education, helping to mold the profession and guaranteeing that pharmacists are equipped to fulfill the ever-changing demands of the healthcare system. This development is indicative of a larger trend in the healthcare industry toward a more flexible, patient-focused, and technologically advanced environment [ 21 ].

Digital transformation in global healthcare

The recent advancements in digital transformation within global healthcare are significantly reshaping the landscape of healthcare and pharmacy services. These transformations are largely driven by the integration of digital technologies, which are redefining the tools and methods used in health, medicine, and biomedical science, ultimately aiming to create a healthier future for people worldwide [ 22 ]. In a 2018 report [ 23 ], Amazon’s potential entry into the $500 billion U.S. pharmacy market, the second-largest retail category, through mail-order and online pharmacies was highlighted as a significant industry disruptor. With licenses in at least 12 states in the US and a strategy focused on bypassing middlemen, Amazon’s historical success positions it to transform the pharmacy landscape, promising enhanced efficiency and cost savings for consumers.

One of the critical areas identified in recent research is the establishment of five priorities of e-health policy making: strategy, consensus-building, decision-making, implementation, and evaluation. These priorities emerged from stakeholders’ perceptions and are crucial for the effective integration and adoption of digital health technologies​ [ 24 ]. This holistic approach is increasingly relevant for scholars and practitioners, suggesting a focus on how multiple stakeholders implement digital technologies for management and business purposes in the healthcare sector [ 25 ]​​. The deployment of technological modalities, encompassed within five distinct clusters, can facilitate the development of a digital transformation model. This model ensures operational efficiency through several dimensions: enhanced operational efficacy by healthcare providers, the adoption of patient-centered methodologies, the integration of organizational factors and managerial implications, the refinement of workforce practices, and the consideration of socio-economic factors [ 25 ].

Studies focusing on value creation through digital means suggest healthcare as a consumer-centric realm ripe for center-edge transformations, characterized by self-service and feedback cycles. These transformations are vital in addressing inherent tensions between patients and physicians, steering the focus towards value co-creation and service-dominant logic [ 26 ]. Participatory design and decision-making approaches are emphasized for enhancing health information technology’s performance and institutional healthcare innovation. Such approaches are particularly crucial in developing national electronic medical record systems and improving chronic disease treatment through electronic health records. Additionally, telehealth research integrates patients’ perceptions, contributing to the understanding of technology, bureaucracy, and professionalism within healthcare [ 27 ].

The impact of health information technology (HIT) on operational efficiencies is profound. Empirical studies, such as those by Hong and Lee [ 28 ], Laurenza et al. [ 29 ], and Mazor et al. [ 30 ], demonstrate positive correlations between HIT and patient satisfaction, quality of care, and operational efficiency. However, challenges remain, as Rubbio et al. [ 31 ] highlight deficiencies in resilience-oriented practices for patient safety. Organizational and managerial factors in digital healthcare transformation also receive significant attention. Hikmet et al. [ 32 ] and Agarwal et al. [ 33 ] investigate the role of organizational variables and barriers in HIT adoption, whereas Cucciniello et al. [ 34 ] delve into the interdependence between implementing electronic medical records (EMR) systems and organizational conditions. Further, Eden et al. [ 35 ] and Huber and Gärtner [ 36 ] explore workforce adaptations and the implications of health information systems in hospitals that can increases transparency of work processes and accountability. Lastly, examining healthcare financialization and digital division provides an international perspective, contrasting the regulated environment in the EU with the US’s use of online medical crowdfunding as a potential solution to reduce bankruptcy [ 37 ; 38 ]. Collectively, these studies suggest a comprehensive model where stakeholders leverage digital transformation for management, enhancing operational efficiency in healthcare service providers.

Marques and Ferreira [ 39 ] performed a systematic literature review of digital transformation in healthcare, spanning the period from 1973 to 2018. Utilizing the SMARTER (Simple Multi-attribute Rating Technique Exploiting Ranks) method, 749 potential articles were analyzed, culminating in the prioritization and selection of 53 articles for detailed examination. The literature was organized into seven thematic areas: (1) Integrated management of IT in healthcare, (2) Medical images, (3) Electronic medical records, (4) IT and portable devices in healthcare, (5) Access to e-health, (6) Telemedicine, and (7) Privacy of medical data. It was observed that the predominant focus of research resides in the domains of integrated management, electronic medical records, and medical images. Concurrently, emerging trends were identified, notably the utilization of portable devices, the proliferation of virtual services, and the escalating concerns surrounding privacy. See Fig.  2 for visual representation of multifaceted digital transformation in healthcare.

Visual representation of multifaceted digital transformation in healthcare: a synthesis of provider-patient dynamics, HIT impact, and strategic management. HIT; health information technology, HC; healthcare, EMR; electronic medical records. IT; information technology, Pt.; patient

Telehealth and online pharmacy advancements in pandemic management

In the realm of online pharmacies and telehealth, digital health technologies have been instrumental in managing the COVID-19 pandemic through surveillance, contact tracing, diagnosis, treatment, and prevention. These technologies ensure that healthcare, including pharmacy services, is delivered more effectively, addressing the challenges of accessibility and timely care. The role of telemedicine and e-pharmacies, in particular, has been emphasized in improving access to care worldwide. By enabling remote consultations and drug delivery, these platforms are making healthcare more accessible, especially in regions where traditional healthcare infrastructure is limited or overstretched [ 40 ].

The Canadian Virtual Care Policy Framework advocates for the swift adoption and integration of virtual care, propelled by the COVID-19 pandemic. It emphasizes enhancing access and quality, ensuring equity and privacy, and devising appropriate remuneration models, employing a collaborative, patient-centered approach while addressing digital disparities. During the COVID-19 pandemic, Canadian provinces and territories rapidly adopted virtual health care, leading to 60% of visits being virtual by April 2020, up from 10 to 20% in 2019. However, these implementations were often temporary and not fully integrated into healthcare systems. By August 2020, virtual visits decreased to 40%, with variations across regions, while provinces and territories used temporary billing codes for these services. The framework’s “Diagnostique” provides a thorough analysis of policy enablers and strategies for virtual care, underscoring the need for comprehensive policy and partnership engagement [ 41 ]. In the context of digital transformation in pharmacy, the Hospital News article outlines the application and infrastructure of telepharmacy services in Canada, highlighting the geographical challenges and the early adoption of telepharmacy in certain regions since 2003. It notes the use of various technologies like Medication Order Management, Videoconferencing, and Remote Camera Verification. Although lacking specific quantitative data, the article underscores the necessity for expanded telepharmacy services to ensure uniform care quality across diverse locations [ 42 ].

Similarly, Telehealth offers extensive resources for patients and providers in the United States, emphasizing programs like the Affordable Connectivity Program and Lifeline to facilitate access. The Health Resources and Services Administration enhances telehealth through support services, research, and technical assistance, reflecting a significant outreach impact [ 43 ]. The Office for the Advancement of Telehealth (OAT) under Health Resources and Services Administration (HRSA) works to improve access to quality health care through integrated telehealth services in the US. It supports direct services, research, and technical assistance, with over 6,000 telehealth technical assistance requests sent to Telehealth Resource Centers and approximately 22,000 patients served [ 44 ].

Internationally, In the UK, the National Health Service (NHS) spearheads digital health and care, providing significant innovation opportunities through vast data management. Support for digital health spans various stages, from discovery with organizations like Biotechnology and Biological Sciences Research Council (BBSRC) and Intelligent Data Analysis (IDA) research group, to development with networks such as Catapults and CPRD, and delivery with entities like the Academic Health Science Networks (AHSNs) and DigitalHealth.London. Regulatory bodies like the Medicines and Healthcare products Regulatory Agency (MHRA) and NICE ensure safety and efficacy. The collaborative ecosystem involves academic, healthcare, and industry stakeholders, aiming to enhance health and care services through technology and innovation [ 45 ].

In Australia, the government’s investment of over $4 billion into COVID-19 telehealth measures has facilitated universal access to quality healthcare. This initiative has provided over 85 million telehealth services to more than 16 million patients, with approximately 89,000 healthcare providers engaging in this service delivery. From 1 January 2022, telehealth services, initially introduced in response to COVID-19, will become an ongoing part of Medicare. This will allow eligible patients across Australia continued access to general practice (GP), nursing, midwifery, and allied health services via telehealth, deemed clinically appropriate by the health professional [ 46 ].

European nations such as the Netherlands, Austria, and Italy are at the forefront of implementing cross-organizational patient records, significantly enhancing telehealth communication and facilitating cross-border healthcare. The role of strong government support in advancing telehealth is pivotal. Ursula von der Leyen, the President of the European Commission, has been a prominent advocate for eHealth. She proposed the establishment of a European Health Data Space to streamline health data exchange across member states. France, a leader in telehealth legislation for nearly a decade, has pioneered a public funding scheme for tele-expertise at a national scale. Despite these advancements, challenges like legislative barriers and the lack of consistent political direction continue to impede progress in the telehealth domain​ [ 47 ].

The Asia-Pacific region anticipates a surge in telehealth adoption driven by digital demand and pandemic-induced behavioral changes, while South East Asia exhibits widespread telehealth growth across healthcare aspects [ 48 ]. The telehealth adoption across the Asia-Pacific region has shown remarkable growth between 2019 and 2021 and is projected to continue rising by 2024. China’s adoption nearly doubled to 47% and is expected to reach 76%. Indonesia’s usage more than doubled to 51%, with a forecast of 72%. Malaysia and the Philippines both anticipate reaching a 70% adoption rate, increasing from 30% to 29%, respectively. India’s adoption is projected to more than double to 68%, while Singapore, which had a significant increase from 5 to 45%, is expected to achieve a 60% adoption rate. This trend indicates a robust uptake of telehealth services in the region [ 48 ].

Global telemedicine and E-pharmacy policy dynamics

In the context of telemedicine and e-pharmacy regulations within South East Asia, a notable distinction emerges with Singapore, Malaysia, and Indonesia being the only countries to have formalized legal frameworks governing both telemedicine practices and the dissemination of electronic information. In these countries, tele-consultation is restricted to patients already under the care of healthcare practitioners or as part of ongoing treatment, specifically in Singapore and Malaysia. Additionally, for scenarios requiring more intensive medical intervention, such as new referrals, emergency cases, or invasive procedures, both Malaysia and Indonesia mandate physical presence and face-to-face consultations, emphasizing a cautious and regulated approach to remote healthcare. In Malaysia, the regulations further stipulate that online prescriptions, excluding narcotics and psychotropic substances, are permissible solely under the continuation of care model, reflecting a judicious use of digital prescription services [ 49 ].

In Central and Eastern Europe (CEE), telemedicine has experienced substantial growth, primarily catalyzed by the COVID-19 pandemic, which necessitated rapid advancements in technology and alterations in healthcare practices. The region’s robust digital infrastructure, coupled with the innovative drive of local companies and the challenges posed by an aging demographic, has significantly contributed to this expansion. According to the European Commission’s Market Study on Telemedicine, the global telemedicine market was projected to grow annually by 14% by 2021, a rate that was likely surpassed due to the pandemic’s impact. More specifically, the Europe Telehealth Market, valued at US $6,185.4 million in 2019, is anticipated to witness an annual growth rate of 18.9% from 2020 to 2030. This trend underscores the increasing reliance on and potential of telemedicine in addressing healthcare needs in the CEE region [ 50 ].

In the Middle East, telehealth and telepharmacy, have seen varied degrees of adoption and progress. Despite attempts to reform healthcare delivery in the region, the progress of telemedicine has been somewhat slow, with certain expectations yet to be fully realized. However, there has been notable development in the use and adoption of these technologies [ 51 ]​. In a survey comparing the utilization of digital-health applications in Saudi Arabia and the United Arab Emirates (UAE), it was observed that a higher percentage of Saudi participants have utilized online pharmacy services (48%) compared to the UAE (36%). Conversely, awareness of teleconsultation services without prior use was higher in the UAE (43%) than in Saudi Arabia (35%). Retention data indicates that a significant proportion of users in both countries continue to engage with these services, with 80% of Saudi participants and 71% of UAE participants using teleconsultations at varying frequencies. Notably, a substantial majority of users in Saudi Arabia reported regular use of online pharmacies (90%), slightly higher than the UAE (78%), reflecting robust ongoing engagement with these digital health modalities. Notably, consumer adoption of telehealth products is primarily driven by time savings (48%) and convenience (47%), with 24-hour accessibility and efficacy both influencing 34% of users. Affordability and personal recommendations are also notable factors, while a wide range of options and quality are lesser but relevant considerations [ 52 ].

In response to the COVID-19 pandemic, a cross-sectional study was conducted among 391 licensed community pharmacists in the United Arab Emirates to assess the adoption and impact of telepharmacy services. The study revealed a predominant use of telepharmacy services, particularly via phone (95.6%) and messaging applications (80.0%). The findings highlighted that pharmacies with more pharmacists and those operating as part of a group or chain were more likely to implement a diverse range of telepharmacy services. The study identified significant barriers to telepharmacy adoption in individual pharmacies, including limited time, inadequate training, and financial constraints. There was a noticeable shift in service provision during the lockdown, with an increased reliance on telepharmacy, especially among pharmacies serving 50–100 patients per day. However, a reduction in services such as managing mild diseases and selling health products was observed during the lockdown period. The study concluded that telepharmacy played a pivotal role in supporting community pharmacies during the pandemic, with its expansion facilitated by the UAE’s advanced internet infrastructure, supportive health policies, and widespread digital connectivity [ 53 ]. Collectively, these insights reflect a global shift towards integrating and enhancing telehealth services as a response to emerging healthcare needs and technological advancements.

Unni et al. [ 54 ] provided an extensive review of telepharmacy initiatives adopted globally during the COVID-19 pandemic. Predominantly, virtual consultations were utilized to enable at-risk patients and others to remotely access pharmacists, thereby monitoring chronic illnesses, optimizing medication usage, and providing educational support [ 55 ]. Home delivery of medicines was widely implemented to decrease the necessity for in-person visits and mitigate exposure risks [ 56 ]. Additionally, patient education was prioritized to ensure effective management of health conditions from a distance [ 57 ]. Notably, a network of hospitals in China developed cloud-pharmacy care, allowing patients to consult pharmacists via text and the internet, while Spain utilized information and communication technologies for remote pharmaceutical care [ 58 ; 59 ]. Zero-contact pharmaceutical care, introduced in China, facilitated online medication consultations, eliminating direct contact [ 60 ]. The Kingdom of Saudi Arabia and other regions adapted new e-tools and teleprescriptions to enhance service accessibility [ 61 ]. The U.S. focused on credentialing pharmacists for telehealth to ensure competent service provision, and New Zealand implemented hotline numbers for phone consultations to further reduce physical visits [ 62 ; 63 ]. These initiatives reflect a significant shift towards innovative, technology-driven solutions in pharmaceutical care during a global health crisis. Refer to Fig.  3 for a graphical depiction of the worldwide distribution and applications of telepharmacy initiatives.

The global distribution of telepharmacy programs with an analysis of geographical distribution, technological applications, and associated benefits

Tracing the Private Sector’s Impact on Healthcare’s Technological Transformation

The role of the private sector in the fourth industrial revolution.

The World Economic Forum underscores the private sector’s leading role in digital inclusion and the acceleration of actions pertinent to the Fourth Industrial Revolution. This revolution affects economies, industries, and global issues profoundly, indicating the private sector’s critical role in driving technological advancements and digital platforms that deliver impactful healthcare solutions [ 64 ].

Mapping digital transformation in healthcare

A comprehensive analysis performed by Dal Mas et al. [ 65 ] meticulously maps the intricate terrain of digital transformation in healthcare, spotlighting the private sector’s instrumental role. Initially, the investigation encompassed an extensive array of diverse studies, leading to the identification of five main areas of digital technologies: smart health technologies, data-enabled and data collection technologies, Industry 4.0 tools and technologies, cognitive technologies, and drug & disease technologies. These domains frame the future research pathways, primarily steered by the private sector’s innovative drive. A significant proportion of the literature addresses healthcare broadly, suitable for both private and public sectors, yet a notable segment specifically focuses on the private sector’s endeavors, with a pronounced emphasis on the pharmaceutical domain [ 66 ; 67 ].

Public-private partnerships in healthcare delivery

The highlighted technologies, including digital platforms and telemedicine, exemplify the private sector’s trailblazing contributions to digital healthcare advancements. For instance, public-private partnerships (PPP) in India have emerged as a pivotal model for realizing universal healthcare (UHC), especially against the backdrop of acute healthcare shortages and urban-rural divides. Notably, mega PPP projects have successfully deployed technology-enabled remote healthcare (TeRHC), demonstrating its feasibility and impact in reaching isolated communities. These initiatives, overcoming various challenges, serve as a compelling example for global adoption, underscoring the transformative role of PPP in healthcare delivery [ 68 ].. Furthermore, a considerable majority of the literature in telemedicine underscores the necessity for profound research implications, yet a significant minority suggests policy implications [ 69 ; 70 ], reflecting a complex synergy between the private and public sectors in sculpting the digital healthcare framework [ 71 ]. This synthesis underscores the private sector’s critical influence in propelling the digital transformation in healthcare, charting a course that progressively fuses technological innovation with healthcare provision.

A study highlights Indonesia’s strategic initiatives to capitalize on telehealth business opportunities, driven by the Ministry of Research and Technology’s robust support for Technology-Based Start-up Company schemes [ 72 ]. With a demographic boon of 298 million from 2020 to 2024, escalating non-communicable diseases (71%), and a growing base of 222.4 million JKN participants, the stage is set for transformative growth. Despite a critical shortage of health workers (0.4 doctors per 1000 population), the enthusiasm for telemedicine is evident, with 71% satisfaction in hospital telemedicine and 32 million active telehealth users. The Ministry’s foresight in fostering technology start-ups, exemplified by the TEMENIN platform with its 11 health platforms, is steering Indonesia towards a future where high-quality healthcare is accessible and sustainable.

Lab@AOR: a model for PPPs in healthcare sector

The “Lab@AOR” initiative stands as a paradigmatic example of PPPs effectuating digital transformation within the healthcare sector. This strategic collaboration, between the University Hospital of Marche and Loccioni [ 73 ], a private entity, underscores the capacity of PPPs to navigate intricate challenges, stimulate international cooperation, and contribute to the development of sustainable, patient-centric healthcare solutions. Specifically, Lab@AOR was instituted to confront the nuanced challenges associated with the robotization of healthcare service delivery, highlighting the initiative’s role in fostering technological advancement through public and private sector synergy [ 74 ]. The project illustrates the evolution of Lab@AOR through three main phases: the pioneering stage, where groundwork for collaboration was laid; the nurturing stage, where collaborative exchanges were fostered; and the harvesting stage, wherein the potential of the PPP was fully unleashed. In the pioneering stage, Lab@AOR focused on a critical healthcare service component: the in-hospital preparation of medications for oncological patients. The University Hospital of Marche identified a need for innovation to improve service quality, efficiency, and safety, while Loccioni sought a real-life setting to test and refine its robotized system, APOTECAchemo [ 75 ]. This convergence of needs led to a symbiotic partnership aiming to enhance healthcare delivery through technological advancement.

During the nurturing stage, the partnership expanded the scope of APOTECAchemo to include non-oncological medications and developed additional tools like APOTECAps for manual preparation support. This phase was characterized by intensive collaboration, knowledge sharing, and continuous innovation, demonstrating the dynamic capability of the PPP to adapt and evolve in response to emerging healthcare challenges. The harvesting stage marked the international expansion of Lab@AOR, transforming it from a local initiative to an international community focused on leveraging digitalization and robotization to improve care quality and patient-centeredness. The PPP’s growth was catalyzed by its open perspective and inclusive approach, engaging entities from various cultural and institutional contexts, and fostering a network of 31 nodes across 19 countries and 3 continents.

Advancements in telehealth business models and frameworks

In their investigative study, Velayati et al. [ 76 ] delved into the articulation of emergent business models in telehealth and scrutinized the deployment of established frameworks across a variety of telehealth segments. The research spanned an extensive range of sectors, notably telemonitoring, telemedicine, mobile health, and telerehabilitation, alongside telehealth more broadly. The scope further extended to encompass niche areas such as assisted living technologies, sensor-based systems, and specific fields like mobile teledermoscopy, teleradiology, telecardiology, and teletreatment, presenting a thorough analysis of the telehealth landscape. Within the telemedicine and telehealth services sector, Barker et al. [ 77 ] introduced the Arizona Telemedicine Program (ATP) Model, a quintet-layer approach aimed at efficiently distributing telemedicine services throughout Arizona. Complementing this, Lee and Chang [ 78 ] proposed a four-component model specifically tailored for mobile health (mHealth) services pertaining to chronic kidney disease, focusing on offering a cost-effective platform for disease support and management. In the realm of telemonitoring, Dijkstra et al. [ 79 ] utilized the Freeband Business Blueprint Method (FBBM), which includes service, technological, organizational, and financial domains, to facilitate multiple telemonitoring services. Furthermore, the systemic and economic differences were explored in care coordination through Business to customer (B2C) and business (B2B) models for telemonitoring patients with chronic diseases, with the B2C model’s economic advantages were highlighted [ 80 ].

General telemedicine frameworks also received attention. Lin et al. [ 81 ] constructed a six-component framework analyzing major telemedicine projects in Taiwan, while Peters et al. [ 82 ] developed the CompBizMod Framework in Germany, encompassing value proposition, co-creation, communication and transfer, and value capture, designed to evaluate and enhance competitive advantages in telemedicine. In the specialized field of telecardiology, a comprehensive nine-component sustainable business model was crafted to facilitate mutual benefits for service providers and patients. This model emphasizes the importance of a holistic approach in ensuring the longevity and effectiveness of healthcare delivery within this domain [ 83 ]. Meanwhile, Mun et al. [ 84 ] presented a suite of five teleradiology business models aimed at providing effective, high-quality, and cost-efficient diagnoses.

The teletreatment sector saw innovative models from Kijl et al. [ 85 ], who designed a model for treating patients with chronic pain, focusing on the interrelation of components in the value network and the role of information technology. Complementarily, Fusco and Turchetti [ 86 ] introduced four models for telerehabilitation post-total knee replacement, emphasizing partnerships between care units and equipment suppliers to reduce costs and waiting lists. The mHealth and assisted living technology sector witnessed the introduction of a wearable biofeedback system model by Hidefjäll and Titkova [ 87 ], which employed Alexander Osterwalder’s Business Model Canvas and focused on a comprehensive commercialization process. Additionally, Oderanti and Li [ 88 ] presented a seven-component sustainable business model for assisted living technologies, aimed at encouraging older individuals to invest in eHealth services while reducing the pressure on health systems. These diverse clusters and models reflect the multifaceted nature of telehealth, each tailoring its approach to meet the unique demands of its domain. They collectively aim to optimize service delivery, stakeholder involvement, cost efficiency, and patient care quality, marking significant strides in the ongoing evolution of digital healthcare.

Challenges and biases in healthcare technology

One key aspect is the emergence of novel medical technologies and their potential biases. These biases are often a result of insufficient consideration of patient diversity in the development and testing phases. For example, disparities in the performance of medical devices like pulse oximeters among different racial groups have been observed, potentially due to a lack of diverse representation in clinical trials. This indicates a tendency for the development of healthcare technologies that may not adequately serve all patient populations [ 89 ]. A study on the profitability and risk-return comparison across health care industries highlights the use of return on equity (ROE) as a measure of profitability from a shareholder’s perspective. This measure combines profit margin, asset utilization, and financial leverage. The study analyzed financial data of publicly traded healthcare companies, providing insights into the financial dynamics of the healthcare sector. It revealed that while companies like Pfizer Inc. and UnitedHealth Group reported similar profitability, they had substantial differences in profit margin and asset utilization, indicating diverse financial strategies within the healthcare sector. This study underscores the complexity of financial performance in healthcare, where profitability measures need to be balanced with risk assessment and the broader impact on healthcare provision​ [ 90 ].

Additionally, an article discusses the benefits, pitfalls, and potential biases in healthcare AI. It emphasizes that as the healthcare industry adopts AI, machine learning, and other modeling techniques, it is seeing benefits for both patient outcomes and cost reduction. However, the industry must be mindful of managing the risks, including biases that may arise during the implementation of AI. Lessons from other industries can provide a framework for acknowledging and managing data, machine, and human biases in AI. This perspective is crucial in understanding how the integration of advanced technologies in healthcare can be influenced by the drive for profitability and efficiency, possibly at the expense of equitable and patient-centered care [ 91 ; 92 ].

Cosmeceuticals in the online pharmacy market

Cosmeceuticals, a term derived from the combination of cosmetics and pharmaceuticals, refer to a category of products that are formulated to provide both aesthetic improvements and therapeutic benefits. These products, typically applied topically, are designed to enhance the health and beauty of the skin, going beyond the mere cosmetic appearance. The exploration of cosmeceuticals in the online pharmacy market reveals a multifaceted and rapidly expanding industry. Bridging the gap between cosmetics and pharmaceuticals, they form a significant portion of the skincare industry. Cosmeceuticals are formulated from various ingredients, with their main categories being constantly discussed and analyzed in the scientific community [ 93 ]. They have taken a considerable share of the personal care industry globally, constituting a significant part of dermatologists’ prescriptions worldwide [ 94 ]. This surge is further fueled by increasing consumer demand for effective and safe products, including anti-aging skincare cosmeceuticals, a need which has been intensified by concerns over pollution, climate change, and the COVID-19 pandemic [ 95 ].

The global cosmeceuticals market is experiencing robust growth. Valued at USD 56.78 billion in 2022, it’s projected to expand to USD 95.75 billion by 2030, with a compound annual growth rate (CAGR) of 7.45%. This growth trajectory is propelled by the innovative integration of bioactive ingredients known for their medical benefits​ [ 96 ]. Another report confirms this upward trend, indicating the market was worth $45.56 billion in 2021 and is on a path of significant growth to USD 114 billion by 2030. The global disease burden is significantly impacted by various skin diseases, with dermatitis, psoriasis, and acne vulgaris among the most prevalent, contributing 0.38%, 0.19%, and 0.29% respectively. The pervasive nature of these conditions drives a substantial demand for effective treatments, propelling the integration of cosmeceuticals into the online pharmacy market. This integration not only offers convenient access to a range of therapeutic skincare products but also caters to the rising consumer inclination towards self-care and preventive healthcare. As a result, the online availability of cosmeceuticals is not just addressing the immediate needs of individuals suffering from skin conditions but is also reshaping the landscape of personal healthcare by making specialized treatments more accessible and customizable [ 97 ]. See Fig.  4 .

The left panel presents the market share distribution for key segments in the cosmeceuticals industry in 2021, including Skin Care Segment, and Supermarket & Specialty Stores, for Asia Pacific Revenue, with percentages for each category. The right panel displays the market value progression over time from 2021 to the projected value in 2030, with bold numbers indicating the value in billion USD for each year. The lower horizontal bar chart depicts the percentage contribution of various skin diseases to the global disease burden

Several factors are contributing to this expansion of the cosmeceuticals market. The market is driven by innovation in natural ingredients and a significant penetration of internet, smartphone, and social media applications, which attract potential consumer populations and reflect constantly changing consumer behavior [ 98 ]​​. The cosmeceuticals market’s robust CAGR and revenue share, especially in regions like Asia Pacific, further signify its burgeoning presence and potential within the global market [ 99 ]​. Integration into online pharmacies is a key aspect of this market’s evolution, offering easier access to these products for a wider customer base. As the market continues to grow, it’s anticipated that the blend of cosmeceuticals with online pharmaceutical platforms will become increasingly seamless, offering consumers a diverse range of accessible, effective, and beneficial skincare and health products. This integration is likely to be driven by the growing trend of e-commerce and digitalization in healthcare and personal care sectors.

The landscape of online pharmacies, particularly concerning cosmeceuticals, is evolving. While the overall penetration for non-specialty drugs in mail-order and online pharmacies is low, they represent a significant portion of specialty prescription revenues at 37%. Despite this, only 13% of consumers consider these as their primary pharmacy choice, indicating a growing but still emerging market​​​​. Strategies are in place to enhance the market appeal of these pharmacies, focusing on speed, convenience, and personalized experiences, such as video telehealth visits, to attract a broader consumer base [ 100 ].

The dissertation “L’Oréal Portugal: A Digital Challenge for the Active Cosmetics Division” authored by Ascenso [ 101 ] provides an in-depth examination of the impact of digital evolution on the Portuguese cosmeceutical sector and its implications for L’Oréal, a significant cosmetics company. It posits that while L’Oréal has foundational digital competencies, the rapidly evolving digital landscape presents a broad spectrum of potential risks and opportunities. The study details the operations of L’Oréal’s Active Cosmetics Division, which manages brands predominantly sold in pharmacies and parapharmacies, and explores the potential repercussions of digitalization on L’Oréal Portugal’s strategic and operational frameworks. Furthermore, the thesis highlights the expanding role of e-pharmacies and the need for legal reforms to facilitate their operation. It discusses the prevalent trends in the cosmetic industry, such as the increasing demand for natural, male-focused, and environmentally friendly products. The dissertation scrutinizes L’Oréal’s strategic pillars, including innovation, acquisition, and regional growth, emphasizing the need for the company to integrate advanced technologies and recalibrate its business methodologies in light of digital progression [ 101 ]. Although L’Oréal has initiated some digital strategies targeting consumers and pharmacies, there’s a recognized need for an intensified focus on digital marketing aimed at clients. An exploratory attempt by L’Oréal to implement an online ordering platform for pharmacies did not meet success, indicating possible industry unreadiness for such advancements. This case study serves as a critical examination of how traditional companies in the pharmaceutical and cosmetics sectors must adapt to the digital age’s challenges and opportunities [ 101 ].

In a collaborative endeavor with L’Oréal, an associated digital agency provided a comprehensive suite of services that encompasses the full management of social media pages, the development of e-commerce websites, the establishment of Customer Relationship Management (CRM) platforms tailored for pharmacies, and the execution of digital campaigns leveraging QR codes, SMS marketing, and newsletters. These digital tools confer a competitive edge, facilitating a deeper comprehension of consumer behavior and the potential to augment value extraction from customer interactions. For the laboratories, particularly those associated with cosmetics, the advantages are twofold: an increase in sell-out figures, thereby enhancing direct sales to end consumers, and a boost in sell-in metrics, reflecting a rise in transactions to pharmacies or wholesalers. The online ordering feature, as noted by João Roma, a manager at La Roche-Posay, could result in a cacophony of processes if laboratories were to individually develop distinct methods. He advocates for the utilization of pre-existing platforms, such as the established e-learning infrastructure, to spearhead ventures into the online marketplace [ 101 ].

A survey conducted specifically for L’Oréal’s e-learning platform, cosmeticaactiva.pt [ 102 ], across the Portuguese landscape garnered responses from 324 participants, comprising 71% general pharmacists, 13% technical assistants, 8% directors, 7% individuals responsible for procurement from laboratories, and 2% beauty/cosmetic advisors. The findings from this survey underscore the pervasive adoption of digital tools within the pharmacy sector: 82% of respondents affirmed the presence of their pharmacies on social media platforms, 80% reported the use of basic management software, 64% indicated the deployment of advanced management systems, 61% were conversant with online ordering systems directed at laboratories, 38% utilized a store locator, 28% had an established website presence, and a smaller segment of 12% offered online shopping facilities.

Another survey conducted within this study to evaluate the significance of dermocosmetic products in pharmacies yielded a mean importance rating of 4.38 out of 5, indicating that a majority of pharmacists consider these products to be highly important to their business operations. Factors critical to the differentiation of a proficient laboratory/supplier were innovation and cost-effectiveness, with mean scores of 1.9 and 2.7 respectively, on a scale from 1 (most important) to 5 (least important). A substantial majority of pharmacists, amounting to 81.8%, perceive their pharmacies as beacons of innovation and modernity. Detailed interviews elucidated that digital tools are indispensable in augmenting sales for cosmeceutical products by catalyzing demand—a dynamic not feasible with medicinal products. These tools are paramount in managing customer loyalty, facilitating enhanced communication with existing clients via online and mobile channels. Despite the challenges posed by digitalization, particularly in the realms of logistics and human resources, the management at L’Oréal is well-equipped to swiftly adapt to the evolving business landscape, as evidenced by the proactive adoption and integration of these digital strategies [ 101 ] as illustrated in Fig.  5 .

Results from Ascenso [ 101 ] survey assessing digital challenges for L’Oréal in the Portuguese cosmeceutical sector. Digital Tools Usage in Pharmacies (upper left) : the bar chart showing the percentage of respondents using various digital tools in pharmacies. Suppliers’ Choosing Factors (upper right) : the bar chart displaying the mean scores of factors that distinguish a good laboratory/supplier. General Pharmacists Opinion (lower left) : A line chart illustrating the mean ratings of pharmacists’ opinions on whether the pharmaceutical sector is modern, changing, conducive to innovations, adapted to consumer needs, and more developed than other sectors. Importance of Digital Development Tools for Pharmacies (lower right) : A vertical bar chart demonstrating the mean scores for the importance of different digital development tools for pharmacies

The digital transformation strategies, exemplified by companies like L’Oréal, extend beyond the mere targeting of end consumers, encompassing the perspectives of various stakeholders, including retailers. This broadened focus reflects a holistic and integrated approach to digital marketing and customer engagement, indicative of a larger trend within the market. The significance of digital channels in facilitating comprehensive customer interaction and brand development is increasingly recognized. The distinction of organizations such as L’Oréal in their digital initiatives highlights the competitive advantage that can be garnered through innovative digital strategies.

The receptiveness of industry professionals, such as pharmacists, to emerging digital trends, along with the readiness of companies to engage in non-face-to-face sales models, marks a paradigm shift in traditional sales and distribution methods. This shift is reflective of a broader market trend where digital platforms are becoming integral to the customer journey. Furthermore, the potential for online sales in specialized sectors, such as dermocosmetics, and the benefits that organizations derive from the technological advancement of their client base, underscore an escalating acknowledgment of e-commerce and digital tools as crucial elements of a business strategy. This trend, with L’Oréal as a prime example, emphasizes the broader market movement towards digital transformation, not merely as an option but as a necessity for maintaining relevance and competitiveness in an ever-evolving market landscape.

The global regulatory landscape for cosmeceuticals

Sophisticated regulatory legislation and enforcement mechanisms characterize many developed countries such as the USA, EU Member States, Canada, and Japan. These nations, along with influential organizations like the World Health Organization (WHO), significantly shape international market rules and regulations due to their market size and regulatory capacity [ 103 ]. The WHO is particularly noted for its crucial role in setting global standards, with a focus on developing and promoting international standards related to food, biological, pharmaceutical, and similar products [ 104 ]. In contrast to pharmaceuticals, the cosmetic industry necessitates a more advanced international regulatory framework due to consumers’ extensive exposure to these products. The distinction between cosmetics and pharmaceuticals varies significantly across different countries, with the USA employing a voluntary registration system for cosmetics and the EU and Japan requiring mandatory product filings prior to marketing [ 105 ]. Concerns over the safety of pharmaceutical and cosmetic products are highlighted, with an increasing consumer focus on “natural, ecological, and clean” products [ 106 ]. However, the lack of a regulatory framework for these categories underscores the need for more advanced regulations to mitigate health risks.

Intergovernmental cooperation is emphasized, with the US and EU portrayed as dominant players in the pharmaceutical and cosmetic industries, respectively. Regulatory capacity, which is essential for defining, implementing, and monitoring market rules, varies among countries and markets. This capacity depends on several factors, including staff expertise, statutory sanctioning authority, and the degree of centralization of regulatory authority [ 103 ]. The regulatory systems of the EU and US are explored, focusing on their unique approaches to medicine authorization and regulation. The European Medicines Agency (EMA) in the EU and the Food and Drug Administration (FDA) in the US serve as pivotal regulatory bodies [ 107 ; 108 ]. The EMA’s centralized procedure and the FDA’s premarket approval process are detailed, along with subsequent postmarket regulatory procedures. For instance, EU and US cosmetic regulations are compared, revealing differences in their approaches and the evolution of the EU’s regulatory landscape through various amendments and directives. In particular, directive 76/768/EC has been superseded by Regulation (EC) N° 1223/2009, serving as the principal regulatory framework for finished cosmetic products in the EU market. This regulation enhances product safety, optimizes the sector’s framework, and eases procedures to promote the internal cosmetic market. Incorporating recent technological advancements, including nanomaterials, it maintains an internationally acknowledged regime focused on product safety without altering existing animal testing prohibitions [ 109 ].

The Eurasian Economic Union’s (EAEU) regulatory framework for medicines and medical devices is detailed, including the legal framework established for regulating the circulation of these products. The conformity assessment methods, such as the EAC Declaration and the State Registration process, are required for manufacturers to demonstrate their products’ compliance with the standards [ 110 ]. Armenia is also part of the EAEU’s legal framework, which aims to unify regulations for the production and registration of pharmaceuticals and medical products by 2025. This unification is expected to reduce administrative costs for manufacturers and improve medicinal products for patients. Despite significant developments in the cosmetics industry, Armenia does not have an extensive regulatory framework for it. Prior to joining the EAEU, the only regulation concerning cosmetic products was the Order of the Minister of Health of the Republic of Armenia on “Hygiene Requirements of the Production and Safety of Perfume-Cosmetic Products.” Since joining the EAEU, Armenia has unified its national legislation with EAEU regulations, but there are challenges and gaps in the direct applicability of the EAEU’s technical regulations in the country [ 111 ].

In the context of the necessity for clear regulatory framework stems from two reasons. Firstly, cosmeceuticals - products straddling cosmetics and drugs - demand intensified regulatory attention. Examples include the 2007 FDA seizure of Jan Marini’s Age Intervention Eyelash, which contained the drug ingredient bimatoprost, and products boasting human stem cell cultured media, which claim rejuvenating effects but may pose safety risks due to minimal oversight [ 112 ]. A noted 1450% increase in FDA warnings (from 4 to 62 letters) between 2007 and 2011 and 2012–2017, with 8 targeting stem cell ingredient promotions, underscores the growing concern [ 113 ]. The FDA’s limited capacity to identify and assess potential drug-adulterated cosmetics raises concerns.

The second aspect focuses on the necessity for a more comprehensive and unbiased scientific and medical perspective in the FDA’s ingredient review process. The Personal Care Products Safety Act proposes a balanced committee formation including industry, consumer, and medical representatives, yet advocates for the inclusion of specialized professionals like chemists, dermatologists, toxicologists, and endocrinologists. Specific ingredients like diazolidinyl urea and quarternium-15, although effective antimicrobials, are flagged for potential skin allergy risks and formaldehyde release. The preservative 4-methylisothiazolinone, banned in Europe for rinse-off products, is noted for increasing allergic contact dermatitis cases in the US [ 114 ]. The lag in US cosmetic regulation compared to the EU is acknowledged, with the Personal Care Products Safety Act considered a significant advancement, albeit in need of further refinement [ 115 ].

The importance of consumer safety in the global regulatory landscape for cosmeceuticals, particularly for products that blur the line between cosmetics and pharmaceuticals, is a critical issue due to several key factors. Firstly, the cosmeceutical market is expanding rapidly, driven by new ingredients promising various skincare benefits like anti-aging and photoprotection. This growth necessitates clear regulatory guidelines to ensure that these products are safe and their claims are clinically proven. The FDA, for instance, differentiates between cosmetics and cosmeceuticals based on their intended use, particularly if a product is marketed as a cosmetic but functions in a way that affects the structure of the human body, classifying it as a cosmeceutical [ 116 ].

Secondly, the legal and regulatory distinctions between drugs and cosmetics are significant. Drugs are subject to FDA approval based on their intended use in treating diseases or affecting the body’s structure or function, whereas cosmetics are not. This difference becomes crucial when products are marketed with drug-like claims but are not regulated as drugs, potentially leading to consumer safety issues. For example, botanical cosmeceuticals, which contain natural ingredients like herbal extracts, need thorough evaluation to ensure consistency in therapeutic effects [ 117 ]. Additionally, cosmeceutical manufacturers must be careful with marketing and advertising claims to avoid legal implications. Misleading claims can lead to lawsuits and regulatory actions, as seen in past cases where companies faced consequences for unfounded product claims. Moreover, the FDA advises cosmeceutical manufacturers to follow Good Manufacturing Practices (GMP) to reduce the risk of misbranding or mislabeling. These guidelines include production practices and specific warning statement guidelines, emphasizing the importance of substantiating the safety of these products [ 118 ].

The global regulatory landscape for online pharmacy

Online pharmacies pose various risks to consumers, including the potential health hazards from counterfeit or substandard medications and the inappropriate use of prescription drugs. The regulatory landscape for these pharmacies varies significantly across nations, with some countries like the United States implementing specific laws, while others, such as France, have instituted outright bans [ 119 ]. The European Union, for instance, has implemented a mandate effective from 1 July 2015, which requires member states to adhere to legal provisions for a common logo specific to online pharmacies. This is coupled with an obligation for national regulatory authorities to maintain a registry of all registered online medicine retailers, as detailed by the European Medicines Agency [ 120 ]. Furthermore, the sale of certain medications online within the EU is permissible, contingent upon the registration of the pharmacy or retailer with respective national authorities​ [ 121 ]. Additionally, the Council of Europe’s MEDICRIME Convention introduces an international treaty that criminalizes the online sale of counterfeit medicinal products, enforcing prosecution irrespective of the country in which the crime is perpetrated [ 122 ].

Switzerland presents a unique stance, where Swissmedic strongly advises against the online purchase of medicines due to the high risk of illegal sourcing and poor quality. However, Swiss mail-order pharmacies with a valid cantonal license to operate a mail-order business are exempted from this advisory​ [ 123 ]. The Swiss Mail-Order Pharmacists Association and its affiliates, such as Zur Rose AG and MediService AG, actively advocate for a modern and equitable regulation of mail-order medicine sales​ [ 124 ]. The legislative framework is further bolstered by the Federal Act on Medicinal Products and Medical Devices, which regulates therapeutic products to guarantee their quality, safety, and efficacy​ [ 125 ]. In the Middle East, community pharmacy practice is predominantly governed by national Ministries of Public Health or equivalent governmental entities, with most community pharmacies being privately owned​ [ 126 ]. The region’s involvement in the Global Cooperation Group, which encompasses various international regulatory bodies like the EMA and USFDA, signifies a collaborative approach towards drug regulatory affairs in the MENA region [ 127 ]. Despite these advances in regulatory collaboration, it is notable that currently no specific regulations have been detected for online purchases from online pharmacies in the Middle East, highlighting a significant area for potential regulatory development. Furthermore, a notable transition is observed in pharmacy education across several Middle Eastern nations, with an inclination towards introducing Pharm.D degrees to replace traditional pharmacy degrees, reflective of evolving educational standards in the pharmaceutical field [ 128 ]. This shift in education parallels the need for updated regulatory frameworks, especially in the context of the burgeoning online pharmacy sector.

Furthermore, Australia permits the sale of both Prescription-Only Medicines (POMs) and Over-the-Counter (OTC) medications online, provided that brick-and-mortar pharmacies comply with all relevant laws and practice standards [ 129 ]. In contrast, South Korea maintains a stringent stance, prohibiting the online sale of both POMs and OTC medicines, with sales confined exclusively to physical stores registered with the Regulatory Authority (RA) [ 130 ]. China, Japan, Russia, Singapore, and Malaysia exhibit a more selective regulatory framework. China and Russia allow the online sale of OTC medicines only, with China imposing additional restrictions on third-party e-commerce platforms and Russia having introduced a draft law in December 2017 to formalize this practice [ 131 ; 132 ]. Japan permits the online sale of certain OTC medicines, explicitly excluding specific substances such as fexofenadine and loratadine [ 133 ]. Similarly, Singapore and Malaysia endorse the online sale of specific OTC medicines only, adopting a “buyers beware” approach to caution consumers about the associated risks [ 134 ; 135 ]. Lastly, the legal landscapes in India and Indonesia remain ambiguous. India’s RA has effectively banned the online sale of medicinal products, yet this prohibition lacks legislative backing. Indonesia, too, grapples with unclear regulations, leaving the legal status of online pharmacies indeterminate [ 136 ].

In response to these risks, several initiatives have been developed to guide and certify online pharmacies. In the United States, LegitScript offers certification to online pharmacies that comply with criteria such as appropriate licensing and registration [ 137 ]. Similarly, the Verified Internet Pharmacy Practice Sites (VIPPS) program, accredited by the National Association of Boards of Pharmacy, ensures pharmacies adhere to licensing requirements in the states where they dispense medications [ 138 ]. Internationally, the Health On the Net Foundation has introduced the HONcode, an ethical standard for health websites globally. This code certifies sites that provide transparent and qualified information. However, due to the absence of international harmonization, the HONcode’s certification is limited to US and Canadian pharmacies verified by VIPPS [ 139 ]. The lack of a harmonized international approach presents significant challenges. Consumers do not have access to a comprehensive, global repository of all certified pharmacies. The diverse certification schemes are not well articulated or interconnected, leading to consumer unawareness about their significance or existence. Moreover, enforcing standards across different legal jurisdictions is complex without a unified agreement. To enhance consumer protection, it is imperative to develop and promote a standardized, minimal international code of conduct for online pharmacies. Such a code would unify requirements and allow all initiatives to clarify their roles under a common framework. Adequate oversight in the borderless online pharmacy market can only be achieved through collaborative efforts. To visualize the infographic of the global regularity landscape for the online pharmacy see Fig.  6 .

Comprehensive representation of the regulatory landscape for global online pharmacies, detailing international and national initiatives, certification programs, and conventions aimed at minimizing risks associated with the purchase of medications via online platforms

Technological innovations and Future trends in global pharmacy

The global pharmacy sector is undergoing a transformative shift, driven by the rapid advancement of technological innovations. As the world becomes increasingly digital, the integration of cutting-edge technologies like Artificial Intelligence (AI) and blockchain is setting the stage for a new era in pharmaceutical care and management. These advancements promise to revolutionize the industry by enhancing efficiency, accuracy, and security, ultimately leading to improved patient outcomes and a more streamlined healthcare experience [ 140 ].

Walgreens, in partnership with Medline, a telehealth firm, has developed a platform for patient interaction with healthcare professionals via video chat. AI’s role extends to inventory management in retail pharmacies, allowing pharmacists to predict patient needs, stock appropriately, and use personalized software for patient reminders. Although not all inventory management software in retail pharmacies utilizes AI, some, like Blue Yonder’s software developed for Otto group, demonstrate the potential of AI in predicting product sales with high accuracy, thus enhancing supply chain efficiency [ 141 ; 142 ]. At the University of California San Francisco (UCSF) Medical Center, robotic technology is employed to improve patient safety in medication preparation and tracking. This technology has prepared medication doses with a notable error-free record and surpasses human capabilities in accuracy and efficiency. It prepares both oral and injectable medicines, including chemotherapy drugs, freeing pharmacists and nurses to focus on direct patient care. The automated system at UCSF receives electronic medication orders, with robotics handling the picking, packaging, and dispensing of individual doses. This system also assembles medications on bar-coded rings for 12-hour patient intervals and prepares sterile preparations for chemotherapy and intravascular syringes [ 143 ].

In the realm of global pharmacy, blockchain technology emerges as a pivotal force, driving advancements across various facets of healthcare and pharmaceuticals. At the forefront of its application is the enhancement of supply chain transparency [ 144 ]. Blockchain’s immutable ledger ensures the provenance and legitimacy of medical commodities, offering an unprecedented level of visibility from manufacturing to distribution. This is particularly vital in areas plagued by counterfeit drugs, where systems like MediLedger are instrumental in verifying the legality and essential details of medicines [ 145 ].

The utility of blockchain extends to the implementation of smart contracts — scripts processed on the blockchain that bolster transparency in medical studies and secure patient data management [ 146 ]. These contracts find extensive use in advanced medical settings, as evidenced by a blockchain-based telemonitoring system for remote patients and Dermonet, an online platform for dermatological consultation [ 147 ].

Furthermore, blockchain is revolutionizing patient care through patient-centric Electronic Health Records (EHRs). By decentralizing EHR maintenance, blockchain empowers patients with secure access to their historical and current health records [ 148 ]. Prototypes like MedRec and systems such as MeD Share exemplify how blockchain can provide complete, permanent access to clinical documents and facilitate the sharing of medical data between untrusted parties, respectively, ensuring high information authenticity and minimal privacy risks [ 149 ; 150 ]. In verifying medical staff credentials, blockchain again proves invaluable. Systems like ProCredEx, based on the R3 Corda blockchain protocol, streamline the credentialing process, offering rapid verification while allowing healthcare entities to leverage their existing data for enhanced transparency and assurance about medical staff experience [ 151 ].

The integration of blockchain with Internet of Things devices for remote monitoring marks another leap forward, significantly bolstering data security. By safeguarding the integrity and privacy of patient data collected by these devices, blockchain mitigates the risk of tampering and ensures that only authorized parties can access sensitive information [ 152 ]. Besides, a blockchain-based drug supply chain initiative, PharmaChain, utilizes AI for approaches against drug counterfeit and ensures the drug supply chain is more traceable, visible, and secure. For online pharmacies, this means a more reliable supply chain and assurance of drug authenticity, crucial for maintaining trust and safety [ 153 ].

In response to the COVID-19 pandemic, the PharmaGo platform has emerged as an innovative solution in Sri Lanka, revolutionizing the delivery of pharmacy services. As traditional pharmacies grapple with the challenges of meeting all customer needs in one location, PharmaGo addresses this by providing a comprehensive online pharmaceutical service. It allows customers to access a wide range of medications through a single platform, reducing the need to visit multiple pharmacies. Utilizing image processing technology, pharmacy owners can accurately identify prescribed medicines, while the system’s predictive analytics forecasts future drug demands, enhancing stock management. Additionally, PharmaGo’s AI-powered medical chatbot offers real-time guidance, ensuring a seamless and efficient customer experience. This platform represents a significant advancement in healthcare accessibility and pharmacy service delivery in the pandemic era [ 154 ]. In the same context, ontology-based medicine information system, enhancing search relevance through a chatbot interface was presented by Amalia et al. [ 155 ]. Addressing conventional search engines’ limitations in interpreting data relationships, it employs semantic technology to represent metadata informatively. The ontology as a knowledge base effectively delineates disease-medicine relationships, with evaluations indicating a 90% response validity from the chatbot, offering a robust reference for medical information retrieval and its semantic associations.

Future trends for the digital transformation of in the pharmaceutical sector

Future trends for the digital transformation of pharmacies globally are heavily influenced by the transformative impact of digital technologies on healthcare delivery. The integration of telemedicine, electronic health records, and mobile health applications is pivotal in enhancing patient care. These technologies are instrumental in improving data sharing and collaboration among healthcare professionals, increasing the efficiency of healthcare services. Additionally, they offer significant potential for personalized medicine through data analytics and play a crucial role in patient engagement and self-management of health. The importance of these technologies in creating a more connected and efficient healthcare system is underscored, marking a significant shift in the global healthcare landscape [ 156 ].

In the pharmaceutical sector, the COVID-19 pandemic has catalyzed a significant shift towards Pharmaceutical Digital Marketing (PDM), particularly for over-the-counter drugs. This shift focuses on utilizing online pharmacies and digital platforms for targeted advertising, directly reaching consumers. The trend towards purchasing OTC drugs online has grown, driven by the convenience and efficiency of digital channels. While PDM faces challenges like regulatory constraints and the need for digital proficiency, it offers substantial opportunities in enhancing customer engagement and precise marketing. The future of PDM is poised to be more consumer-centric, integrating advanced technologies like AI, and emphasizing personalized marketing strategies to strengthen brand engagement and customer interaction [ 157 ].

Artificial intelligence holds immense potential to revolutionize the field of pharmacy, offering numerous benefits that can significantly enhance efficiency and patient care. One of the primary applications of AI in this sector is the automation of routine tasks. By utilizing AI, pharmacies can automate critical processes such as prescription processing, checking for drug interactions, and managing inventory. This automation not only streamlines operations but also minimizes the likelihood of human error, thereby increasing the overall efficiency of pharmacies [ 158 ].

Furthermore, AI can play a pivotal role in personalized medication management. This is particularly beneficial for patients with chronic conditions such as diabetes who require careful management of their insulin dosages, as fluctuations in blood sugar levels can lead to serious complications. AI systems can monitor patients continuously, provide timely reminders for medication intake, and dynamically adjust treatment plans based on individual health data. Such personalized management ensures that patients receive optimal care tailored to their specific needs, potentially improving treatment outcomes. Incorporation of AI into electronic health records presents another significant advancement. By integrating AI with EHRs, healthcare providers can access real-time patient data. This integration empowers healthcare professionals to make more informed care decisions, enhancing the quality of patient care. Moreover, it significantly reduces the likelihood of medication errors, a critical concern in healthcare.

Likewise, AI’s capability to analyze extensive patient data is invaluable. It can identify patterns and trends in medication adherence, detect potential drug interactions, and pinpoint adverse drug reactions. These insights are crucial for healthcare professionals and researchers. By understanding these patterns, they can develop more effective medication adherence strategies and support systems, contributing to better patient outcomes and advancing the overall field of pharmaceutical care.

In the expansive realm of chemical space, the pharmaceutical industry faces the continual challenge of identifying new active pharmaceutical ingredients (APIs) for diverse diseases [ 159 ]. High throughput screening (HTS), despite its advancements in recent decades, remains resource-intensive and often yields unsuitable hits for drug development. The failure rate of investigational compounds remains high, with a study citing only a 6.2% success rate for orphan drugs progressing from phase I to market approval [ 160 , 161 ].

Machine learning presents a transformative approach to this challenge. It offers an alternative to manual HTS through in silico methodologies. ML-driven drug discovery boasts several advantages: it operates continuously, surpasses the capacity of manual methods, reduces costs by decreasing the number of physical compounds tested, and early identifies negative characteristics of compounds, such as off-target effects and sex-dependent variability [ 162 ].

A substantial advancement in the realm of machine learning has emerged from major pharmaceutical entities, notably AstraZeneca, in conjunction with research institutions. This progress is evidenced by the development of an innovative algorithm that demonstrates both time efficiency and effectiveness in the sphere of drug discovery. The recent introduction of this algorithm significantly enhances the process of determining binding affinities between investigational compounds and therapeutic targets. It surpasses traditional in silico methods in terms of performance. The application of this algorithm underscores the remarkable potential of machine learning in accelerating the identification and development of novel therapeutic agents [ 163 ].

Moreover, the proficiency of machine learning in managing vast and intricate datasets has rendered it indispensable in research focused on cancer targets, utilizing diverse and extensive datasets. This approach is fundamental in numerous drug discovery initiatives, especially those targeting various forms of cancer. A wide array of ML techniques, ranging from supervised to unsupervised learning, are employed to discern chemical attributes that are indicative of potential therapeutic efficacy against a spectrum of cancer targets. This methodology is crucial in identifying novel compounds that could be effective in cancer treatment, leveraging the rich and complex data available in oncological research [ 164 ].

The digital transformation in the pharmacy sector is significantly reshaping healthcare delivery, driven by the integration of cutting-edge technologies like Artificial Intelligence and blockchain. This transformation is marked by a substantial growth in the digital pharmacy market, with a projected annual growth rate of 14.42%, leading to a market volume of approximately $35.33 billion by 2026​​.

One major aspect of this transformation is the growing reliance on online pharmacy platforms, largely influenced by the COVID-19 pandemic. Consumer trust in online medication purchases has significantly increased, indicating a shift towards digital healthcare solutions. The adoption of telehealth services, including telepharmacy, has surged, with patient adoption in the United States increasing from 11% in 2019 to 46%. This shift towards digital-first services enhances convenience and access to care but also introduces regulatory challenges, particularly in maintaining patient safety and quality standards in the rapidly evolving online healthcare environment​​.

The cosmeceuticals market, a segment within online pharmacies, is experiencing robust growth. Cosmeceuticals, which bridge the gap between cosmetics and pharmaceuticals, have become a significant part of the skincare industry. The market, valued at USD 56.78 billion in 2022, is projected to expand to USD 95.75 billion by 2030. This expansion is driven by factors like innovation in natural ingredients and significant penetration of internet, smartphone, and social media applications. Despite the growth, the overall penetration for non-specialty drugs in mail-order and online pharmacies remains low, representing a significant portion of specialty prescription revenues. The evolving landscape of online pharmacies in the cosmeceuticals sector reflects a trend towards more accessible and customizable personal healthcare solutions​​.

Technological innovations are setting the stage for a new era in pharmaceutical care and management. AI’s role extends to areas like inventory management in retail pharmacies, where it predicts patient needs and enhances supply chain efficiency. Blockchain technology enhances supply chain transparency and legitimizes medical commodities, especially crucial in areas affected by counterfeit drugs. Blockchain also plays a vital role in patient-centric Electronic Health Records and telemonitoring systems. For instance, PharmaGo, an innovative platform developed in response to the pandemic, provides a comprehensive online pharmaceutical service, demonstrating the significant advancements in healthcare accessibility and pharmacy service delivery​​.

These technological advancements are instrumental in improving data sharing and collaboration among healthcare professionals. They offer significant potential for personalized medicine through data analytics, playing a crucial role in patient engagement and self-management of health. The future trends in the pharmaceutical sector, particularly influenced by the COVID-19 pandemic, indicate a shift towards Pharmaceutical Digital Marketing (PDM) and a more consumer-centric approach. AI’s potential in revolutionizing pharmacy includes automation of routine tasks, personalized medication management, real-time patient data access, and the identification of patterns in medication adherence and potential drug interactions​​.

Data availability

No datasets were generated or analysed during the current study.

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Almeman, A. The digital transformation in pharmacy: embracing online platforms and the cosmeceutical paradigm shift. J Health Popul Nutr 43 , 60 (2024). https://doi.org/10.1186/s41043-024-00550-2

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Cultivating education: Selina Warren’s journey in school gardening

Selina Warren's decadelong dedication to school gardening, from establishing outdoor classrooms to developing innovative curriculum resources, has not only earned her prestigious awards but also transformed Kingfield Elementary School into a hub of outdoor learning and community celebration.

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Kingfield Elementary School student Amelia Prince adds whipped cream to a serving of apple crisp during the school’s annual Growing Gardeners Harvest Meal on Oct. 24, 2019, in Kingfield. Franklin Journal file

KINGFIELD — Selina Warren, kindergarten teacher and school garden coordinator at Kingfield Elementary School, was recently awarded the 2023 Maine Agriculture in the Classroom Teacher of the Year.

Warren began her journey into school gardening over a decade ago, driven by her belief in its ability to enrich learning experiences and promote holistic growth among students.

“I have been involved with school gardening efforts for about 14 years now,” Warren said. “It’s something I am truly passionate about.”

To highlight the benefits of school gardening, Kingfield Elementary School is celebrating Maine School Garden Day 2024 from 9 a.m. to 4 p.m. Saturday. The theme is “Harvesting Knowledge: Nourishing Minds Through School Gardens.” The event will feature workshops and networking opportunities highlighting the benefits of green spaces in education.

Warren described her journey began with school gardening in Skowhegan.

“I embarked on my school garden journey in 2011 at Bloomfield Elementary School in Skowhegan,” Warren said. “At the time I was working on my graduate degree and decided to conduct research on the benefits and impact outdoor learning has on academic progress and student growth.” She established a school garden program that still runs as an afterschool garden club at Bloomfield Elementary School. Advertisement

Gardening program rooted in KES curriculum

In 2012, Warren co-authored the original version of the Growing Gardeners curriculum, which was a spiral bound resource published by the Greater Somerset Public Health Collaborative. Warren said two years ago the Greater Franklin Food Council decided that providing teachers with a school garden resource would be a great way to get more teachers outside gardening with students.

Selina Warren, Kingfield Elementary School kindergarten teacher, won 2023 Maine Agriculture in the Classroom Teacher of the Year. Courtesy Photo/Selina Warren

As a result, she said the council decided to support the Growing Gardeners Curriculum Revision project. The curriculum resource is divided into 20 topics, eight for spring, eight for fall and four for winter. Each topic includes three grade span lessons, one for grades kindergarten to grade two, one for grades three to five, and one for grades six to eight.

Warren emphasized the comprehensive nature of the lessons, aligning with Next Generation Science Standards, Maine Learning Results and Common Core Standards. The resource follows Maine’s growing season and was enhanced digitally in collaboration with University of Maine at Farmington graphic design students.

Warren said when she transferred to Kingfield Elementary School, she decided to start over by constructing the garden classroom and coordinating an even more robust school garden program in 2014 using her experience and knowledge gained at Bloomfield Elementary School.

“The Growing Gardeners Program at KES has not only had a positive impact on student academic progress and growth, but it has also become part of our school culture. Furthermore, it is the joy that keeps me in the teaching profession,” Warren noted.

The garden program runs eight weeks in the fall and eight weeks in the spring . Warren mentioned that beyond those 16 weeks, they engaged extensively in outdoor education, linking lessons from the garden to topics such as the forest and vernal pool ecosystems. Advertisement

“This outdoor space has become a haven for exploration and discovery,” Warren elaborated.

Warren’s vision extends far beyond the confines of the garden classroom. There are many outdoor learning areas at Kingfield Elementary School. “In addition to the garden classroom, we have our forest school classroom and the classroom on the hill,” Warren explained.

The garden classroom has continued to grow and expand in the past decade. Warren said this classroom consists of eight raised beds, a pumpkin patch, a greenhouse, a garden shed, a meeting area, a classroom space complete with a chalkboard and stumps, and a large outdoor learning pavilion.

“Our forest school classroom is located in the forest between the playground and our ball fields,” Warren said. It consists of benches, stumps, a chalkboard, and plenty of fallen trees that are used for balance and imaginative play.

She said there is a mud kitchen in the forest school adjacent to a stream that runs from the vernal pool through the playground. There is a vernal pool in forest school used to engage kindergarten students in their yearly study of ecosystems.

Warren said the classroom on the hill is an outdoor learning area in the forested slopes above the playground. Nearby, the biodiversity field is next to the garden classroom, which has native plants to bring in pollinators. Advertisement

“Our curriculum resource is meticulously crafted to integrate gardening activities with academic content aligned to educational standards,” Warren said. “Each lesson is designed to foster holistic growth, nurturing not only intellectual curiosity but also a deep appreciation for the natural world.”

Warren said they go out to the garden a lot, to use the garden classroom as the platform for journaling, especially right now. This time of year the students in writing workshop work on nonfiction writing.

This is a view of the Summer Garden at Kingfield Elementary School. Photo courtesy of Selina Warren

“The garden is a wonderful platform to practice nonfiction writing,” Warren said. Their approach combines subjects, like teaching the life cycle of a plant: “Last week it was a life cycle of a plant, and so the students will draw a picture and write something they have learned,” she said.

This blend encompasses science, writing and literacy, Warren said. “Integrating science, writing, a read aloud to go with that literacy connection, all the while working on speaking and listening standards.”

Additionally, garden activities include math: “When we are measuring plant growth we are using mathematics, lots of ways to integrate the content areas into what we are doing in the garden,” she said.

Warren said a culture of outdoor learning has been cultivated at Kingfield Elementary School. Advertisement

“Erica Luce, second grade teacher, and I actually collaborated with each other on a place-based curriculum called Place Time which is personal learning and community engagement,” Warren said. “And so, I think that any time our students get the opportunity to take their learning outside, it is a real positive and exciting experience.”

“It was an honor to receive the 2023 Maine Agriculture in the Classroom Teacher of the Year,” Warren said when asked about her reaction to winning the award. She also received the Franklin County Teacher of the Year in 2016 and said that was really wonderful.

“But, you know, the school gardening thing is something that I do above and beyond my regular duties that are outlined in my teacher contract because it is something I am passionate about,” Warren explained. “The recognition of the agriculture teacher of the year was definitely a special one.”

One result of the recognition is networking and professional development, she said.

“I was able to travel to Florida for the National Agriculture in the Classroom conference last June,” Warren said. “I will be traveling to Salt Lake City this June with Maine Agriculture in the Classroom, for the national conference that is being held in Salt Lake City this year, where I will be recognized as 2024 National Excellence in Teaching Agriculture award. I’m super excited about this trip.”

At Kingfield Elementary School, the collaboration with the Greater Franklin Food Council and the Healthy Community Coalition is vital, according to Warren. Advertisement

“Our local SNAP educators visit our school weekly during our Growing Gardeners’ program in both fall and spring,” Warren noted. “They conduct cooking lessons with our students using the produce from our garden. This approach serves as a platform for educating about nutrition and healthy eating, aligning with one of our core values: health and wellness.”

Warren emphasized the significance of this collaboration, especially in managing large groups of children during cooking sessions.

“The professional nutritionists from SNAP-Ed play a crucial role in this partnership,” she added. “They provide invaluable support by bringing additional ingredients, finding suitable recipes, and facilitating the cooking process using our homegrown crops.”

“This fall, the parent volunteer group and the local Masons and Lions Club are actually buying our school a mobile cooking cart and outfitting that cart with all of the appliances and materials that we need to do that cooking on our own,” Warren said. They will continue to have SNAP educators come and provide nutrition education.

Warren said they do their cooking outside. They have a very large outside learning pavilion with electricity. They have been cooking outside for several years since the pavilion was built around 2021 as a result of COVID.

Garden to sprout math, English, science and social studies knowledge

Warren’s efforts have not gone unnoticed. Advertisement

“Selina has been in charge of our garden program for 10 garden seasons,” Luce said. “It truly is her passion. She is often found saying, ‘Let’s plant seeds and sing songs.’”

Warren said the family harvest meal is the highlight of every year.

“One of the most joyful experiences or highlights of every season in our school garden,” Warren said. “Here at KES we are celebrating a decade of gardening. We are a pretty small community, we usually get about 150-plus people in our school garden for our family harvest meal in the fall. Part of the Growing Gardeners’ curriculum is that in the fall students plan and prepare a meal for their family.”

The annual dinner event serves as a platform for community engagement and celebration of local agriculture, Warren explained. Last year they featured a spaghetti dinner, and the year before that they had a pizza event. Warren emphasized community involvement, noting an agricultural fair where families showcased practices like cattle raising and beekeeping.

“It’s a real celebration of not just gardening but local agriculture,” Warren said. She said the harvest meal also offers students opportunities for learning and pride in preparing meals for their families and neighbors.

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